Infant Nutrition and Feeding Resource List

This resource list contains professional and consumer level materials related to infant nutrition and feeding. Resources that are part of the National Agricultural Library (NAL) collection have an NAL call number listed. Lending and copy service information can be found at http://www.nal.usda.gov/fnic/general/lending.html. Materials cannot be purchased from the Library. Please contact the publisher/producer if you wish to purchase any materials on this list.

The following resource lists are related to this topic and can also be found at http://www.nal.usda.gov/fnic/pubs_and_db.html:
Nutrition During Pregnancy and Breastfeeding for Health Professionals, May 1999
Nutrition During Pregnancy and Breastfeeding Resource List for Consumers, April 2000
WIC Materials in the Collection of the National Agricultural Library from 1995-2001, September 2001
WIC Works Food Safety Resource List, April 2001

Each item has been placed in one or more of the following categories, alphabetically by title with the exception of the journal articles that are listed alphabetically by year. The categories are:

BOOKS

Caring for Your Baby and Young Child: Birth to Age 5, revised edition
American Academy of Pediatrics
New York, NY: Bantam Publishing, 1998
Editors: Steven P. Shelov and Robert E. Hannemann
Summary: Outlines what to expect each month of your baby's first year in terms of growth, behavior, and development including nutritional guidelines and tips on feeding, as well as sample menus for each stage of development. The revised version also features such subjects as new findings on how to stimulate infant and child brain development; expanded coverage of breastfeeding techniques and benefits; air bag safety and infant car seats; new guidelines for choosing a child care provider and a revised immunization schedule.

Child of Mine: Feeding with Love and Good Sense
Ellyn Satter
Palo Alto, CA: Bull Publishing, 2000
NAL Call Number: RJ206.S24
Summary: Information and guidance about nutrition, feeding, child development and parenting.

Feeding Our Babies : Exploring Traditions of Breastfeeding and Infant Nutrition
Jacqueline Vincent Priya
Hale, Cheshire : Hochland & Hochland, 1999
NAL Call Number: RJ216.P74 1999
Summary: None available

Guide to Your Child's Nutrition: Making Peace at the Table and Building Healthy Eating Habits for Life
American Academy of Pediatrics
Editors: William H. Dietz and Lorain Stern
New York, NY: Villard, 1999
NAL Call Number: RJ206.A494 1999
Summary: Provides information and strategies needed for the dietary requirements of children from birth through adolescence. Emphasizes the following topics: what's best for newborns; introducing solid foods; nutrition basics for toddlers, school-age children, and adolescents; how to deal with outside influences, including grandparents and TV commercials; identifying food allergies; recognizing and treating eating disorders; alternative diets and supplements; food safety and additives; how to tell if a child is overweight, underweight, etc. Discusses how to plan healthy menus and how to make mealtime a pleasant experience for the entire family.

How to Get Your Kid to Eat...But Not Too Much
Ellyn Satter
Palo Alto, CA: Bull Publishing, 2000
NAL Call Number: RJ206.S25
Summary: This text provides advice to parents concerning the eating patterns and behavior of their child from birth to adolescence. The development of eating habits and attitudes is discussed and the "division of responsibility in feeding" is advocated. This concept separates the parental and child responsibilities for eating behavior: parents are responsible for selecting food and presenting it while the child is responsible for determining how much they will eat. The book includes sections on basic principles of feeding, feeding as your child grows, and special feeding problems.

Infant Nutrition and Feeding : A Reference Handbook for Nutrition and Health Counselors in the WIC and CSF Programs
USDA, Food and Nutrition Service, 1994
NAL Call Number: aTX353.U5 no.288
Summary: Focuses primarily on nutrition for the full-term infant without medical conditions. Provides an overview of basic subjects related to infant nutrition and feeding, and answers some common questions on the nutritional needs of infants, the development of feeding skills, breastfeeding, formula feeding, the introduction of foods, infant feeding practices, food selection and sanitary food preparation and storage, oral health, vegetarian nutrition, and some common
gastrointestinal problems. This handbook is for staff who provide nutrition education and counseling to the parents and guardians of at-risk infants who participate in the Special Supplemental Nutrition Program for Women, Infants, and Children and the Commodity Supplemental Food Program.

Nutrition in Infancy and Childhood, 7^th edition
Christine M. Trahms
New York: NY: McGraw-Hill, 2001
NAL Call Number: pending
Summary: Provides a balanced, comprehensive review of nutrition needs of infants, children, and adolescents, with a practical, clinical focus. Focus on the nourishment of well infants and the special needs of preterm and low-birth-weight infants. Also covers behavior; how food patterns are developed, shaped and changed and current issues related to the development of food patterns for young children, parent and child interactions as they influence food patterns and the use of behavior modification techniques to achieve the acceptance of foods and teaching feeding skills to young children. Also discusses the application of nutrition in special circumstances, such as children who are vegetarians and the prevention of chronic diseases by dietary intervention.

Pediatric Nutrition Handbook, 4^th edition
American Academy of Pediatrics, Committee on Nutrition
Elk Grove Village, IL: American Academy of Pediatrics, 1998
NAL Call Number: RJ206.A49 1998
Summary: A practical, comprehensive, and current source of information on pediatric support. Topics discussed include breastfeeding; formula feeding of term infants; supplemental foods for infants; nutritional needs of preterm infants; infant nutrition and the development of gastrointestinal function; recognition and management of pediatric swallowing disorders; feeding from age 1 year to adolescence; adolescent nutrition; sports nutrition; assessment of nutritional status; protein; energy; carbohydrate and dietary fiber; fats and fatty acids; calcium, phosphorus, and magnesium; iron deficiency; trace elements; vitamins; parenteral nutrition; enteral nutrition; failure to thrive, malnutrition, and anorexia; persistent diarrheal disease; oral rehydration therapy for acute diarrhea; inborn errors of metabolism; dietary management of diabetes mellitus in children; hypoglycemia in infants and children; hyperlipidemia; obesity in children; food sensitivity; nutrition and immunity; nutritional management of children with a chronic illness; nutrition in children with HIV infection; nutrition during pregnancy; nutrition and oral health; community nutrition services; food labeling; diet in the prevention of cancer and hypertension; nutritional aspects of vegetarian diets; fast foods, organic foods, and megavitamins; food safety; new food ingredients; etc.

What to Expect the First Year
Arlene Eisenberg, Heidi E. Murkoff and Sandee E. Hathaway
New York, NY: Workman Publishing, 1996
Summary: Provides a detailed, comprehensive presentation on what to expect during the first year of a child's life. Arranged on a month-by-month basis for each of 12 months, provides a guide to the progress the baby may be expected to be making at this stage. Includes information ranging from breast and bottle feeding to what buy for a new-born, first aid, recipes, and adoption. Includes an extensive index. A final section of ready-reference material includes recipes, common home remedies, a well-organized table of common illnesses, and height and weight charts.

WIC Infant Feeding Practices Study: Summary of Findings
Nazli Baydar
Alexandria, VA: United States. Dept. of Agriculture. Food and Consumer Service. Office of Analysis and Evaluation, 1997.
NAL Call Number: aRJ216.W55 1997
Summary: Results from a one-year longitudinal study of infant feeding practices over the first year of life.

PAMPHLETS, BROCHURES, AND FACT SHEETS

Baby Bottle Tooth Decay and Oral Health in the Child Care Setting
Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion, January 1997
Web site: http://www.cdc.gov/ncidod/hip/abc/facts02.htm

Breast Milk or Formula: Making the Right Choice for Your Baby
Rebecca D. Williams and Isadora B. Stehlin
Food and Drug Administration, Center for Food Safety and Applied Nutrition, revised September 1998
Web site: http://www.fda.gov/opacom/catalog/breastfed.html

Feeding Baby: Nature and Nuture
Dori Stehlin
Food and Drug Administration, Center for Food Safety and Applied Nutrition, March 1991
Web site: http://vm.cfsan.fda.gov/~dms/wh-baby.html

Infant Formula: Second Best but Good Enough
Isadora B. Stehlin
Food and Drug Administration, Center for Food Safety and Applied Nutrition, June 1996
Web site: http://www.fda.gov/fdac/features/596_baby.html

Overview of Infant Formulas
Food and Drug Administration, Center for Food Safety and Applied Nutrition, August 1997
Web site: http://www.cfsan.fda.gov/~dms/ds-inf.html

Parent Express and Baby Care Series
Lexington, KY: University of Kentucky, Family and Consumer Sciences, 1997

Vegan Nutrition in Pregnancy and Childhood
Reed Mangels and Katie Kavanagh-Prochaska
Includes section on infant feeding
Web site: http://www.vrg.org/nutrition/pregnancy.htm

VIDEOCASSETTES

Feeding Your Baby: 8-12 Months
Alimentando a Su Bebe a los 8-12 Meses (Spanish version)
Videocassette (30 min.)(VHS)
Austin, TX: Texas Department of Health, 2000
NAL Call Number: Videocassette no. 2984
Summary: Mothers and fathers talk about feeding their 8-12 month old infants. Developmental feeding cues and the challenges of feeding 8-12 month old infants are highlighted.
Ordering information:
Replicopy
8300 Research Blvd.
Austin, TX 78758
Telephone: (512) 419-1166
Fax: (512) 419-1168
E-mail: replicopy@austin.rr.com
Web site: http://www.replicopy.com

Feeding Your Child: 1-3 Years
Alimentando a Su Niño a los 1-3 Años (Spanish version)
Austin, TX: Texas Department of Health, 2000
Videocassette: (29 min.) (VHS) and instructional materials
NAL Call Number: Videocassette no. 2985
Summary: Three families share their experiences in feeding their 1-3 year old toddlers. Topics covered include parent's influence on food choices, weaning from the bottle, and mealtime is family time.
Ordering information:
Replicopy
8300 Research Blvd.
Austin, TX 78758
Telephone: (512) 419-1166
Fax: (512) 419-1168
E-mail: replicopy@austin.rr.com
Web site: http://www.replicopy.com

Look Who's Eating
Mira quien esta comiendo! (Spanish version)
Austin, TX: Texas Department of Health, 1999
Videocassette: (11:30 min, English) (11:53 min, Spanish)(VHS) and instructional materials
NAL Call Number: Videocassette no. 2972 (English); IPM001204404 (Spanish)
Summary: Explains what signs to look for when your baby is ready for solid foods and includes feeding tips for baby.
Ordering information:
Replicopy
8300 Research Blvd.
Austin, TX 78758
Telephone: (512) 419-1166
Fax: (512) 419-1168
E-mail: replicopy@austin.rr.com
Web site: http://www.replicopy.com
Lesson plans available full text (English): http://www.tdh.state.tx.us/wichd/nut/if00010-s.pdf
Lesson plans available full text (Spanish): http://www.tdh.state.tx.us/wichd/nut/if00010s-s.pdf

Starting solid foods: Lily helps Ana
Empezando con los Alimentos Solidos: Lily ayuda a Ana (Spanish version)
Evanston, IL : AGC United Learning, 2000
Videocassette (12 min.)(VHS)
NAL CALL NO: Videocassette no. 2978 (English); Videocassette no. 2978 (Spanish)
Summary: This program helps new mothers determine when and how to start feeding their babies solid foods. Not beginning too early, introducing foods one at a time, making changes gradually, and the importance of a varied diet are some of the topics covered. Suggestions are also provided for what to do for a choking child, which foods may cause allergies, and what safety precautions you should take when preparing food for your infant.
Ordering information:
AGC United Learning
1560 Sherman Ave. Suite 100
Evanston, IL 60201
Telephone: 800-323-9084 or 847-328-6700
Fax: 847-328-6706
E-mail: info@unitedlearning.com
Web site: http://www.agcunited.com/

INTERNET RESOURCES

The Child Care Nutrition Resource System
Provides recipes, resources and information on preparing meals for children. Particularly useful for participants in USDA's Child and Adult Care Food Program (CACFP).
Web site: http://www.nal.usda.gov/childcare/

Gaining and Growing: Assuring Nutritional Care of Preterm Infants
Provides information to community health professionals about feeding premature and very low birthweight infants.
Web site: http://staff.washington.edu/growing/

Nutrition for Kids
Includes ideas for activities, educational materials, resources, recipes. Developed and maintained by Connie Ever's, MS, RD specializing in promoting the nutritional health of children and adolescents.
Web site: http://www.nutritionforkids.com/

WIC Works Resource System
Provides nutrition services tools for professionals working in the USDA's Special Supplemental Nutrition Program for Women, Infants and Children.
Web site: http://www.nal.usda.gov/wicworks/

NEWSLETTERS AND RESOURCE LISTS

Feeding Kids Newsletter
Connie Evers
A free electronic newsletter, published bimonthly and sponsored by 24 Carrot Press. Includes a section of "news and views" on child nutrition for parents, educators, and health Professionals.
Web site: http://nutritionforkids.com/Feeding_Kids.htm (Includes archives of previous issues and subscription information.)

Food and Nutrition Resource List for Child Care and Preschool Staff
Shirley King Evans
A compilation of resources done by the Food and Nutrition Information Center at the National Agricultural Library for people involved in the child care profession. Includes food and nutrition education print materials, audiovisuals, and other resources for classroom use. Topics covered are general nutrition, food preparation, food safety, and dietary management. Teaching materials include: food models, games, kits, videocassettes, and lesson plans. Books, reports, and journal articles offer ideas for training staff and volunteers.
Web site: http://www.nal.usda.gov/fnic/pubs/bibs/edu/98-child.htm#intro

Nutrition & Your Child
This quarterly newsletter by the USDA/ARS Children's Nutrition Research Center, is written for parents, health care professionals and educators.
Web site: http://www.bcm.tmc.edu/cnrc/nyc.htm ( Includes archives of previous issues and subscription information.)

Tiny Tummies Online: Good Food for Growing Families
Editor: Sanna Delmonico, R.D.
Food and nutrition newsletter for parents. Features recipes, nutrition information, reviews of new food products and cookbooks, and practical feeding ideas. Published 10 times per year.
Web site (overview and ordering information): http://www.tinytummies.com/

WIC Materials in the Collection of the National Agricultural Library from 1995-2001
Doris Kuehn
A compilation of materials produced or used by the Women, Infants, and Children Supplemental Nutrition Program (WIC) published between 1995 and 2001 and currently available at the National Agricultural Library.
Web site: http://www.nal.usda.gov/fnic/pubs_and_db.html

WIC Works Food Safety Resource List
Mary C. Herrup
This resource list contains professional and consumer level materials related to food safety. Materials listed may be found at the National Agricultural Library or can be borrowed through interlibrary loan.
Web site: http://www.nal.usda.gov/fnic/pubs/bibs/gen/foodsafety.html

JOURNAL ARTICLES (in alphabetical order by year)

GENERAL

"Infant nutrition: Part one." Kanneh, A and Ellis, M. Paediatric Nursing, 11(10): 36-43; quiz 43. 1999.
Abstract: None available

"Nutrition in infancy: evolving views on recommendations." Johnson, Donna B. Nutrition Today, 32(2): 63-68. 1997.
NAL Call Number: RA784.N8
Abstract: Recommendations for infant feeding have evolved with advances in our knowledge of nutritional needs, physiological development, and developmental readiness for food. Professional consensus now indicates that infant feeding decisions are best based on long-term consequences of infant feeding and individual risk factors.

"Infant nutrition. Part 1: Preweaning (0-4 months)." Lambert, E. J. and Hall, M.A. British Journal of Hospital Medicine, 53(11): 567-9. 1995.
Abstract: While human milk is the recommended milk on which to feed healthy term infants, many mothers may choose to bottle feed. This article uses the differences between human and formula milk to highlight important and topical issues in neonatal nutrition. The second part of this article will cover nutrition from weaning to 1 year of age.

"Infant nutrition. Part 2: Weaning-1 year." Lambert, E. J. and Hall, M.A. British Journal of Hospital Medicine, 54(7): 327-30. 1995.
Abstract: The weaning process is vital for infants, not only from the nutritional point of view, but also in establishing normal feeding habits. This article describes the accepted pattern of weaning and the reason behind the nutritional and behavioral problems that commonly arise.

ATTITUDES, PERCEPTIONS, BELIEFS AND PRACTICES

"African-American and Latina adolescent mothers' infant feeding decisions and breastfeeding practices: a qualitative study." Hannon, P.R., et al. Journal of Adolescent Health. 26(6): 399-407. 2000.
Abstract: PURPOSE: To explore minority teen mothers' perceptions of breastfeeding and the influences on infant feeding choices. METHODS: A qualitative study using semistructured ethnographic interviews and focus groups involving 35 Latina and African-American girls in Chicago between the ages of 12 and 19 years who were primiparous and were currently pregnant or had delivered within the past 3 months. RESULTS: Adolescents identified three main influences on infant feeding decisions and practices: (a) their perceptions of the benefits of breastfeeding, (b) their perceptions of the problems with breastfeeding, and (c) influential people. In this study, teens reported no single influence which determined infant feeding choices. The decision to breastfeed was a dynamic process. Teens recognized that breastfeeding offered many benefits including facilitating maternal-child bonding and promoting the baby's health, but concern was raised regarding a potential for excessive attachment between teen mother and baby. Fear of pain, embarrassment with public exposure, and unease with the act of breastfeeding acted as barriers for teenagers who were considering breastfeeding. Teenagers discussed the breast pump as a strategy in dealing with these barriers. The adolescents' mothers continued to be an important influence. CONCLUSIONS: The ranges of perceptions and influences that minority adolescent mothers have identified as affecting their infant feeding choices, illustrated and explained in the teens' own words, are helpful to health care providers as they counsel teen mothers about infant feeding options.

"Examining the correspondence of breastfeeding and bottle-feeding couples' infant feeding attitudes." Shepherd, C.K et al. Journal of Advanced Nursing, 31(3): 651-60. 2000.
Abstract: Examining the correspondence of breastfeeding and bottle-feeding couples' infant feeding attitudes. This report focuses on the comparison of infant feeding attitudes within breastfeeding (n = 126) and bottle-feeding (n = 101) couples and their socio-demographic details. The findings from this study reinforce the view that socio-demographic factors are associated with the mothers' choice of feeding method. However, this study highlights the influence of maternal and of paternal knowledge and attitudes which distinguish between breastfeeding and bottle-feeding couples. Fathers of bottle-feeding babies were found to have limited knowledge of health benefits of breastfeeding to both mothers and infants. However, bottle-feeding mothers, when compared with their partners, were more supportive towards bottle feeding and less negative towards breastfeeding. Fathers of breastfeeding babies, compared with their partners were found to be less aware of the benefits of breastfeeding. Furthermore, breastfeeding mothers when compared with their partners were more supportive towards breastfeeding. Fathers of both bottle and breast feeding babies were also found to be more embarrassed than their partners about mothers in general breastfeeding in front of nonfamily members. It seems that bottle-feeding mothers and all fathers could be better prepared in many aspects of breastfeeding by the nursing professions to allay the many misconceptions and the social embarrassment associated with breastfeeding, by providing appropriate information and support.

"Explaining infant feeding style of low-income black women." Corbett, K.S. Journal of Pediatric Nursing, 15(2): 73-81. 2000.
Abstract: Unstructured interviews were conducted with 10 low-income black women to explore infant feeding style. Formula-feeding with early introduction of cereal in the bottle was the most common pattern used by mothers in the first 3 months. By 6 months, formula-fed infants had a complex diet of a variety of foods. Half the women intended to breast-feed, but only one exclusively breast-fed. Beliefs about healthy infants and crying influenced feeding. There was a lack of knowledge about and support for breast-feeding in these women's environment. Support and advice about infant feeding from the health care system were uneven.

"The breast or the bottle? Determinants of infant feeding behaviors." Wagner, C.L. and Wagner, M.T. Clinics in Perinatology, 26(2): 505-25. 1999.
Abstract: Although various trends have placed breastfeeding in and out of vogue, in the twentieth century the greater availability of human milk substitutes mandates that a woman choose her infant's feeding method. It appears that intrapsychic factors or life experiences, as well as certain social conditions, influence that choice. For example, the economic state of society historically has had significant impact on the role of women and the value placed on woman's unique biologic contributions. Likewise, personality and attitudinal factors also may act as potential mediators of observed differences between lactating and nonlactating mothers in their mother-infant interactions. Finally, once the decision to breastfeed or bottle-feed has been made and carried through, additional physiologic mechanisms may mediate conscious behavioral intentions. The phenomenon of human lactation, then, is sensitive to a variety of interrelated factors that can be grouped as follows: (1) individual personality, (2) social forces, and (3) psychophysiologic mechanisms. An in-depth understanding of the specific factors that affect a woman's decision to breastfeed will have far-reaching implications for future educational and interventional programs.

"Cultural influences on infant feeding beliefs of mothers." Kannan, S. et al. Journal of The American Dietetic Association, 99(1): 88-90. 1999.
NAL Call Number: 389.8 Am34
Abstract: None available

"Determinants of infant feeding practices in a low socio-economic area: identifying environmental barriers to breastfeeding." McIntyre, E., et al. Australian and New Zealand Journal of Public Health, 23(2): 207-9. 1999.
Abstract: OBJECTIVE: To identify environmental barriers to breastfeeding. METHOD: Focus groups were conducted with young women, parents-to-be, mothers, fathers and grandmothers in 1996 in northern Adelaide, South Australia (a low socio-economic area). RESULTS: Seven focus groups (4-8 participants per group) were conducted. Breastfeeding was seen as being embarrassing to do in public, and not possible to combine with paid employment. While fathers were not supportive of their partners breastfeeding in public, health professionals were seen as strong advocates of breastfeeding. Bottle feeding was perceived to be more convenient for the mother, more acceptable in public but not as good as breastfeeding for the baby. CONCLUSION: An environmental that enables women to breastfeed is far from being achieved in this low socio-economic area, particularly in relation to breastfeeding in public. IMPLICATIONS: Breastfeeding promotion should have a public health focus, concentrating on creating a supportive breastfeeding environment through a multi- strategy approach aimed not just at mothers but also at the community.

"Early introduction of solid foods among urban African-American participants in WIC." Bronner, Y.L. et al. Journal of The American Dietetic Association, 99(4): 457-461. 1999.
NAL Call Number: 389.8 Am34
Abstract: Objective: To compare infant feeding practices among low-income, urban, African-American women enrolled in the Special Supplemental Nutrition Program for Women, infants, and Children (WIC) with current recommendations for infant feeding. Design: Longitudinal follow-up of women and their infants who participated in a WIC-based breast-feeding promotion project. Women enrolled prenatally at or before 24 weeks of gestation were followed up until 16 weeks postpartum. Subjects/setting: Two hundred seventeen African-American WIC participants in an urban area. Methods: Data related to infant feeding practices were collected by interviewers who used a structured questionnaire to determine when nonmilk liquids or solids were introduced to the infant. Reported practices were compared with current recommendations. Statistical analysis performed: Contingency table analysis, including x(2) tests, and multivariate analysis using logistic regression. Results: By 7 to 10 days postpartum, approximately a third of infants were receiving some nonmilk liquids or solids; this escalated to 77% by 8 weeks and 93% by 16 weeks postpartum. Women breast-feeding exclusively (ie, not adding nonmilk liquids or solids) were least likely, and women providing mixed feeding (breast milk and formula) were more likely, than women feeding formula exclusively to introduce nonmilk liquids and solids at each data collection time period.
Applications/conclusions: WIC participants who receive instruction about infant feeding nutrition are no more likely than mothers who do not participate in WIC to follow infant feeding guidelines recommended by the American Academy of Pediatrics in regard to the time when solids should be introduced to infants' diet. Our findings suggest the need for WIC to implement more powerful and innovative educational and motivational strategies to help mothers delay the introduction of nonmilk liquids and solid foods until their infants are 4 to 6 months old, as recommended.

"Infant feeding practices of Anglo American and Asian Indian American mothers." Kannan, S. et al. Journal of the American College of Nutrition, 18(3): 279-286. 1999.
NAL Call Number: RC620.A1J6
Abstract: Objective: To compare infant feeding practices of Anglo-American (AA) (n = 25) and Asian-Indian American (AIA) mothers (n = 25) residing in the southeastern United States. Methods: Feeding practices (breast-feeding, formula-feeding, introduction of solid foods) were assessed at infant ages one, three, six, nine and twelve months for a total of 250 interviews conducted in the home. Mothers' sources of information about infant feeding practices and dietary intakes of their infants were collected (24-hour recalls). Results: Compared to their AIA counterparts, AA mothers breast-fed for significantly longer durations and introduced formula and solid foods into the infants' diet at a later age (p < 0.05). Throughout the first year, AA mothers relied primarily upon health professionals for infant feeding information compared to AIA mothers, who sought information primarily from the family network during the first six months and relied more on health professionals during the second six months of the infant's life. Throughout the first twelve months, infants of both groups exceeded 100% of the RDA for energy, protein, calcium, iron, vitamin A, and vitamin C. Conclusion: Health professionals, including nutrition educators, should educate AIA mothers about and encourage AA mothers to follow current feeding recommendations and guidelines about breast-feeding, formula-feeding and introducing solid foods.

"Infant feeding practices of low-income, African-American, adolescent mothers: An ecological, multigenerational perspective." Bentley, M., et al. Social Science and Medicine. 49(8): 1085-100. 1999.
Abstract: The early introduction of non-milk foods among African-American infants has been well documented. Several studies report the addition of semi-solids as early as 1-2 weeks of age. This study investigated, through ethnographic, repeat indepth interviews with teen mothers and grandmothers of infants, the determinants of such feeding practices and the inter-generational factors involved in infant feeding decision-making. Nineteen adolescent mothers were recruited from Baltimore City WIC programs. The teen mothers were interviewed in their homes during four separate visits and the grandmothers at least twice. Ethnographic field guides focused on questions about what, why and how infants were fed and on the 'ethnotheories' of parenting and infant care in this population. All interviews were taped and transcripts were analyzed using text retrieval software. Results confirmed that it is the cultural norm to feed cereal in the bottle and to feed other semi-solid foods within the first month of life. Most grandmothers played the dominant role in deciding what the infant should eat and the timing of the introduction of solids. This pattern occurred both because grandmothers had extensive physical access to their grandchildren and because teen mothers were dependent upon grandmothers. The use of qualitative research methods, with an ecological, multi-generational focus, provides a rich description of the context within which infant feeding decisions are made.

"Characteristics of responders and non-responders in an infant feeding study." Shepherd, C.K. et al. Journal of Public Health Medicine. 20(3): 275-80. 1998.
Abstract: BACKGROUND: Few studies have fully investigated and described the characteristics of non-responders in infant breast feeding studies. Examination of the characteristics of non-responders enhances this understanding and provides information on the representativeness of the sample actually investigated. METHODS: As part of a larger local longitudinal study, couples whose babies were due to be born during the three months of the study in the autumn of 1995, at two local maternity hospitals, were approached by midwives to participate in the study of infant feeding patterns and determinants, including interviews, questionnaires and postal survey. From the 648 eligible mothers, 91 (14 per cent) were not approached, 233 (35.9 per cent) consented but were not interviewed, 256 (39.5 per cent) consented and were interviewed and 68 (10.5 per cent) refused to participate (non-responders) in the longitudinal study. To make a comparison between the 'responders' (i.e. the 233 who consented but were not interviewed and the 256 who consented and were interviewed) and non-responders (the 68 who refused to consent), appropriate data were collected on their socio-demographic characteristics, their feeding intentions and their feeding behaviour. RESULTS: Univariate analysis revealed a number of significant differences between responders and non-responders. However, log-linear analysis of these differences indicated that the main factors that differentiated between responders and non-responders were social class, smoking habit and actual feeding behaviour. When comparing the feeding intention at the time of 'booking', the non-responders compared with the responders were less likely to intend to breastfeed and more likely to be uncertain about their feeding intentions. Following delivery non-responders compared with responders were more likely to bottle feed their babies. By the time of discharge, of the non-responders, 83.6 per cent were bottle feeding in comparison with 47.3 per cent of responders who were also bottle feeding. CONCLUSIONS: In this study non-responders were found to be more similar to bottle-feeding responders than to breastfeeding responders. Furthermore, non-responders were more likely to be smokers, from lower social class and to bottle feed. This study also showed that the non-responders were more undecided about their feeding intention at the time of the booking visit. Invariably a higher percentage of mothers who were undecided at the booking visit chose to bottle feed their babies at discharge. These results highlight the impact of failing to include information from non-responders when conducting research which examines patterns of infant breastfeeding and attitudes towards it.

"Diet and disadvantage: observations on infant feeding from an inner city." Daly, A., et al. Journal of Human Nutrition and Dietetics, 11(5): 381-389. 1998.
NAL Call Number: QP141.A1J58
Abstract: Background: There are few detailed nutritional studies analysing dietary intakes and weaning practices of inner city infants aged 0-12 months. Pasteurized cow's milk (PCM) is not recommended as a main drink until after 1 year of age, although early usage is still common. Premature introduction of pasteurized cow's milk is associated with increased risk of iron deficiency anaemia. Methods: We therefore prospectively examined the dietary effect of early introduction of pasteurized cow's milk en the nutritional intake of 100 infants (mean age at recruitment 7.8 months), whose mothers had already elected to introduce cow's milk before the recommended age of 12 months in a deprived inner city area. In addition, a retrospective questionnaire on feeding practices and feed choices was administered and information on parental education and employment was collected, together with a 3-day dietary diary of weighed intakes at recruitment. Results: The results indicate that weaning practices are handed down from family and friends and are intuitive rather than informed. Over 80% of the infants had intakes of iron, zinc and vitamin D below the reference nutrient intake (RNI) and a further 41% had low vitamin C intakes. Prior to introduction of PCM, there was also misuse of infant formula. Twenty per cent added an extra scoop of powder to the feeds, 10% added milk powder to the bottle before addition of water and 30% used microwave ovens to heat the infant bottle. Conclusion: Feeding practices in a deprived inner city area differed substantially from guidelines and infants were at risk of developing nutrient deficiencies as well as poor feeding practices.

"Infant feeding in Roman antiquity: Prescription and risk." Holman, S.R. Nutrition Today, 33(3): 113-120. 1998.
NAL Call Number: RA784.N8
Abstract: Mistaken ideas about infant feeding of the ancient Romans increased health risks. Nutritionists today may still encounter similar beliefs. This article increases cultural sensitivity.

"Smoking in pregnancy and postpartum: Relationship to mothers' choices concerning infant nutrition." Edwards, N., et al. The Canadian Journal of Nursing Research. 30(3): 83-98. 1998.
Abstract: The objective of this study was to examine the relationship between maternal smoking status and infant nutrition. Women delivering in 5 hospitals in the Ottawa-Carleton region of Ontario were screened for eligibility over a 6-month period in 1993. Follow-up data were collected by telephone at 3 months postpartum using a validated questionnaire. Mothers were retrospectively asked about their infant-feeding choices and their smoking behaviours. Logistic regression analyses were used to determine the significance of demographic factors and maternal smoking behaviours in relationship to 3 feeding practices: bottlefeeding at birth, discontinued breastfeeding by 12 weeks, and introduction of solids by 12 weeks. A total of 796 women participated in the longitudinal study (90% follow-up rate). Less-educated; younger; single, separated or divorced; and foreign-born mothers were more likely to bottle feed at birth. Less educated women more often discontinued breastfeeding before 12 weeks. Mothers who had smoked during part or all of their pregnancy and were smoking at the time of the interview were significantly more likely than non-smokers to bottlefeed at birth or to discontinue breastfeeding by 12 weeks. Current smokers were also more likely than non-smokers to have introduced solid food by 12 weeks. Maternal smoking was a significant predictor of infant nutrition, with other sociodemographic factors taken into account. Smoking status should be included in clinical screening tools for infant nutrition. The relationship between other dimensions of maternal smoking (e.g., timing of quitting attempts, degree of partner support, partner's smoking behaviours) and infant-feeding practices warrants investigation.

"Attitudes, practices, and recommendations by obstetricians about infant feeding." Howard, C.R, et al. Birth. 24(4): 240-6. 1997.
Abstract: BACKGROUND: Little information is available about the degree to which obstetricians promote breastfeeding through patient care practices and educational activities. The purpose of this study was to determine the attitudes, practices, and recommendations of obstetricians regarding infant feeding selection. METHODS: A written survey was mailed to 148 obstetrician/gynecologists in Monroe County, New York (78% response rate, n = 116). RESULTS: Of the 104 physicians in active obstetric practice, 86 percent conducted prenatal discussions about infant feeding with patients, 80 percent recommended breastfeeding, and 68 percent were commonly contacted postpartum by patients to address breastfeeding questions. Overall, 57 percent routinely incorporated these breastfeeding supportive practices into their prenatal and postpartum patient care. Attitudes about obstetric responsibility for infant feeding counselings and about the importance of counseling independently predicted the provision of these services. Infant feeding information was given to patients by 98 percent of obstetricians; 75 percent used written and 39 percent used videotaped materials. Formula company-produced infant feeding literature (41%), pregnancy literature (57%), and free formula offers (61%) were commonly used. Of those surveyed, 58 percent lacked training and 22 percent reported inadequate training in infant nutrition. CONCLUSIONS: Although most obstetricians in Monroe County provide infant feeding education and recommend breastfeeding, most report that their training about infant nutrition is inadequate, and they distribute infant formula company materials and offers to patients. Such discrepancies in patient care are inconsistent with promoting breastfeeding as optimal infant nutrition.

"Health practitioners should consider parity when counseling mothers on decisions about infant feeding methods." Kieffer, E.C., et al. Journal of The American Dietetic Association, 97(11): 1313-1316. 1997
NAL Call Number: 389.8 Am34
Abstract: None available

"How do socioeconomic status and age influence infant food patterns." Nevling, W., et al. Journal of The American Dietetic Association, 97(4): 418-420. 1997.
NAL Call Number: 389.8 Am34
Abstract: None available

"Infant feeding and maternal concerns about stool hardness." Morley, R., et al. Child Care Health and Development, 23(6): 475-8. 1997.
Abstract: From a questionnaire completed by 195 mothers of infants aged 3-12 weeks we found that significantly more formula than breast-feeding mothers had concerns about stool hardness and had sought professional advice, resulting in both increased use of health care resources and more dietary interventions.

"Infant feeding choice among first-time mothers." Keith, K.A. Scholarly Inquiry for Nursing Practice, 11(3): 199-224; discussion 225-9. 1997.
Abstract: The choice of an infant feeding method is a poorly understood phenomenon. In all societies women are the infant feeders, regardless of the method of infant feeding. How women decide on an infant feeding method is not known; the decision making is complex and frequently unconscious. A qualitative study using the methods of grounded theory was undertaken to understand how women make an infant feeding decision. Eight women were interviewed; 14 themes were identified through the analysis of interview transcripts, field notes, researcher memos, and related literature. The themes were distilled into six conceptual categories which were used as a basis for a model: Conceptualization of the Decision-Making Process in Infant Feeding.

"Infant feeding practices of low-income African American women in a central city community." Underwood, S., et al. Journal of Community Health Nursing. 14(3): 189-205. 1997.
Abstract: It is a well-established fact that nutrition is central to the growth and development of all infants. Yet it has been observed that health care professionals are frequently unfamiliar with the most typical infant feeding practices of the clients within the communities they attempt to serve. This observation was apparent during the development of a program in an inner-city community of Wisconsin to support the feeding practices of low-income African American women with low-birth-weight infants. As a result of initial encounters with prospective clients and health care and social service professionals from the targeted community, it was apparent that professionals and staff involved in this project needed to gain an understanding of common infant feeding practices of low-income African American women; a greater awareness of the values, beliefs, and health care practices of the population; and a greater understanding of the impact of poverty on the families within the targeted community. To assist the staff in gaining a better understanding of the influence of culture and economics on infant feeding practices, a study of the infant feeding practices of a select group of low-income African American women was undertaken. The study aimed to (a) gather information that could be used to describe common infant feeding practices of low-income African American women in an inner-city community of Wisconsin and (b) determine the influence of cultural and economic variables on the decisions made by low-income African American women regarding infant feeding. This article presents an analysis and summary of the data collected during the course of the study.

"Maternal employment: does it influence feeding practices during infancy." Earland, J. Journal of Human Nutrition and Dietetics, 10(5): 305-311. 1997.
NAL Call Number: QP141.A1J58
Abstract: Background: Although at least 30% of women with young children participate in the labour force, there has been very little research into the effect of maternal employment on the diets of young children. Increasingly it is being recognised that early feeding practices affect future health and may have a part to play in the development of eating disorders. Therefore it was decided to conduct a study in Sheffield to determine whether maternal employment influences infant feeding practices. Methods: Mothers from social classes I and II (employed n = 27; unemployed n = 28) with infants aged 10-12 months were interviewed in their homes. Information was collected on past and present food and drink consumption, weaning practices, and progression to independent feeding. Results: Employed mothers stopped breast-feeding earlier. This difference became evident after 2 months of age and reached significance at 4 months (P < 0.05). Employed mothers introduced foods earlier and relied more on commercial baby foods, with significantly more spending over 7-12 pounds sterling per week at the time of the survey (P < 0.05). Conclusions: Maternal employment does influence infant feeding practices and consequently may have repercussions on future health. Further studies are needed to investigate the long-term effects of maternal employment on infant feeding practices, particularly amongst lower socio-economic class families.

"Infant feeding behavior: Development in patterns and motivation." Paul, K., et al. Developmental Psychobiology, 29(7): 563-76. 1996.
Abstract: Studies of feeding behaviors in human infants not only provide normative data but also allow analyses of the behavioral regulation. Twenty healthy full-term infants were observed by two examiners and were audiovisually and polygraphically recorded under standard conditions at 2, 10, 18, and 26 weeks of age prior to, during, and after breast- or bottle-feeding. The parameters of sucking, breathing and swallowing significantly changed during the first 6 months of age. At 2 weeks, infants were alert and visually attentive during sucking. Breast-fed infants had more opportunities for intimate social contacts than bottle-fed infants because breast feeding took significantly longer time than bottle feeding. Alert motor activities significantly shifted from the prefeeding to the postfeeding time during the first 6 months of age. Together with an increase in visual exploration and theta index in EEG, this shift seems to relate to developmental changes and interindividual differences in the intrinsic motivation.

"Impact of attitudes on maternal decisions regarding infant feeding." Losch, Mary. Journal of Pediatrics, 126(4): 507-514. 1995.
NAL Call Number: RJ1.A453
Abstract: None available

"Patient education: effects of two teaching methods upon parental retention of infant feeding practices." Gibson-L Pediatric Nursing, 21(1): 78-80. 1995.
Abstract: PURPOSE: The purpose of this study was to test a strategy for improving patient's retention of discharge teaching. METHODOLOGY: A pretest-posttest experimental design was used. Forty postpartum women were randomly assigned to a group. All subjects received infant feeding instruction until they reached criterion on the Infant Feeding Questionnaire. The experimental group received additional instruction on the same material (overlearning). The two groups were compared 2 weeks later on the same questionnaire. Mean scores were compared by a t-test, demographic variables were correlated to outcomes, and effect of race or culture was analyzed by ANOVA. FINDINGS: The pretest showed no significant difference between the groups. Posttest scores were significantly higher for the experimental group. The mother's education was the only demographic variable that was correlated to the results. CONCLUSION: Mothers who receive overlearning beyond the mastery level retain significantly more of the material.

BREAST MILK, INFANT FORMULA AND COW'S MILK

"Infant and follow-on formulas: the next decade." Wells, John. British Nutrition Foundation: Special issue, Nutrition in infancy: Policy, practice and problems in Britain, 23 (suppl.1): 23-34. 1998.
NAL Call Number: TX341.B75
Abstract: None available

"AAP issues recommendations for the use of soy protein-based formulas in infant feeding." Rose, V.L. American Family Physician, 57(11):2876.
Abstract: None available

"Perinatal and infant nutrition: Nucleotides." Nutrition, 14(10): 748-51. 1998.
NAL Call Number: QP141.A1N866
Abstract: Nucleotides (NT) are ubiquitous intracellular compounds of crucial importance to cellular function and metabolism. Much recent interest has focused on NT as components of the non-protein nitrogen fraction of human milk. NT supplementation of infant formula has now been introduced in several countries. Biological effects of NT have been reported in several fields. Dietary NT have been shown to have important effects on several components of the immune system: they may enhance intestinal absorption of iron; they affect lipoprotein and long-chain polyunsaturated fatty acid metabolism; they may alter intestinal flora; and they have been demonstrated to have trophic effects on the intestinal mucosa and liver in several experimental situations. Clinical studies have shown NT supplementation of infant formula reduces the incidence of diarrheal episodes among socioeconomically deprived infants, and enhances catch-up growth in infants born small for gestational age. Further work will continue to try to identify other clinical situations in which NT may have a beneficial role.

"Special formulas in infant nutrition: A review." Maldonado, J., et al. Early Human Development, 53 (Suppl): S23-32. 1998.
NAL Call Number: RG600.E27
Abstract: Special formulas should only be used by medical prescription and for those lactating infants with diagnosed nutritional problems. Lactose-free formulas or those based on soy are the logical choice when the exclusion of lactose from the diet is considered necessary. At present, there is no consensus on the appropriateness of soy formulas for the treatment and prevention of nutritional allergies and current opinion seems to favour hydrolyzed protein formulas. High-degree protein hydrolysate formulas are used to treat lactating infants with an allergy to cow milk proteins or with serious nutritional problems. These formulas are not without risk, as they may contain residual epitopes capable of provoking a severe allergic reaction. Before using these formulas, allergenicity tests should be performed, particularly for highly sensitive infants. The unpleasant taste and high cost of these formulas, in addition to possible nutritional problems, limit their use in the prevention of atopic disease, although their efficacy is well established. Partially protein hydrolysate formulas are only used for preventive purposes and are not suitable for lactating infants with a proven allergy to cow milk. Although these formulas can reduce the incidence or delay the appearance of certain atopic symptoms, they have not been shown to prevent IgE-mediated allergic reactions to cow's milk and so their effectiveness is open to question.

"Infant formula: Second best but good enough." Stehlin, Isadora B., FDA Consumer, 30 (5): 17-20. 1996.
NAL Call Number: HD9000.9.U5A1
Abstract: None available

"Special properties of human milk." Wagner, C.L. et al., Clinical Pediatrics, 35(6): 283-293. 1996.
NAL Call Number: RJ1.C55
Abstract: In this review, several nutritional and non-nutritive differences between mothers' milk and formula and their relationship to neonatal gastrointestinal and immune processes are discussed. The dynamic relationship of human milk as evidenced by its changing composition, unique bio-active and immunologic properties, and specialized cellular components is further delineated. The clinical significance and relevance of these findings to the clinician are then presented. Lastly, educational strategies, their effectiveness in promoting breastfeeding, and an approach that might be taken by the clinician to encourage breastfeeding are outlined.

"Advances in Infant Feeding: Human Milk and Formula. Proceedings of a symposium. Baveno, Italy, 20-21 March 1998." Acta Paediatrica Supplement, 88(430): iv, 1-132. 1999.
NAL Call Number: RJ1.A18
Abstract: None available

DENTAL HEALTH

"Reported infant feeding, oral hygiene and dental attendance patterns in children aged 5 years and under referred for extraction of teeth under general anaesthesia." Hunter, M.L., et al. International Journal of Paediatric Dentistry, 7(4): 243-8. 1997.
Abstract: This study was designed to examine reported infant feeding, oral hygiene, and dental attendance practices in children who had established dental disease before attaining school age. Data were collected by structured interview from the mothers of 150 children aged 5 years and under who were referred to a hospital Paediatric Dentistry Unit for the extraction of teeth under general anaesthesia. Few children in this study had been exclusively breast-fed, and, although unconfirmed by data derived from matched caries-free controls, the development of dental caries would appear to be related to prolonged bottle-feeding, including the use of a night-time bottle until just before weaning, the early introduction and regular consumption of larger than average amounts of confectionery, coupled with reportedly regular but unsupervised toothbrushing. Although decay was already established in over a third of children before they visited a dentist for the first time, little evidence of restorative care was found. It would appear that the primary care services fail this youngest age-group.

"Weaning and dental health." Holt, R.D. Proceedings of the Nutrition Society, 56(1A): 131-138. 1997.
NAL Call Number: 389.9.N953
Abstract: In this paper, the author considers a number of the issues that may be identified from the Committee on Medical Aspects of Food Policy (COMA) report considering weaning and the weaning diet. These issues include: weaning and dental caries or dental erosion; special considerations such as soy-based formulas and sugar-containing medicines; labeling; and fluorides at weaning.

"Infant feeding caries: Part I. A review and trial preventive project." Hicks, T. W., et al. Ontario Dentist, 72(9): 17-9, 22-3. 1995.
Abstract: None available

"Infant feeding caries: Part II. The Simcoe and Muskoka-Parry Sound Health Unit Project." Hicks, T. W., et al. Ontario Dentist, 72(9): 24-6, 33.
Abstract: IFC is a serious and expensive dental health problem affecting about five per cent of children in Simcoe County. Although the habits leading to IFC may be difficult to eliminate, efforts at prevention may be more successful. Health promotion efforts are an economic and superior manner to promote wellness as compared to treatment. If the present project prevents IFC in six children annually in Simcoe County, and two children in Muskoka-Parry Sound, the savings in treatment cost would be greater than the cost of the program. These savings pale in comparison to the enhanced level of dental health enjoyed by children who escape the present and future ravages of IFC. The Simcoe and Muskoka-Parry Sound health units provide a preventive program to ensure that area families are aware of the dangers of IFC and the steps they can take to prevent it. Through a joint venture, the local dental society and the health units were able to develop a superior health promotion program as compared to individual effort. Residents benefit from the promise of improved dental health and the two partners enhance their public credibility. During the 1995 Dental Health Month, the health unit and the dental society cooperated in an additional promotion involving local pharmacies as an adjunct to the present program.

FATTY ACIDS

"Essential fatty acids in infant nutrition: lessons and limitations from animal studies in relation to studies on infant fatty acid requirements." Innis, S.M. The American Journal of Clinical Nutrition, 71(1 Suppl): 238S-44S. 2000.
NAL Call Number: 389.8.J824
Abstract: Animal studies have been of pivotal importance in advancing knowledge of the metabolism and roles of n-6 and n-3 fatty acids and the effects of specific dietary intakes on membrane composition and related functions. Advantages of animal studies include the rigid control of fatty acid and other nutrient intakes and the degree, timing, and duration of deficiency or excess, the absence of confounding environmental and clinical variables, and the tissue analysis and testing procedures that cannot be performed in human studies. However, differences among species in nutrient requirements and metabolism and the severity and duration of the dietary treatment must be considered before extrapolating results to humans. Studies in rodents and nonhuman primates fed diets severely deficient in alpha-linolenic acid (18:3n-3) showed altered visual function and behavioral problems, and played a fundamental role by identifying neural systems that may be sensitive to dietary n-3 fatty acid intakes; this information has assisted researchers in planning clinical studies. However, whereas animal studies have focused mainly on 18:3n-3 deficiency, there is considerable clinical interest in docosahexaenoic acid (22:6n-3) and arachidonic acid (20:4n-6) supplementation. Information from animal studies suggests that brain and retinal concentrations of 22:6n-3 plateau with 18:3n-3 intakes of approximately 0.7% of energy, but this requirement is influenced by dietary 18:2n-6 intake. Blood and tissue concentrations of 22:6n-3 increase as 22:6n-3 intake increases, with adverse effects on growth and function at high intakes. Animal studies can provide important information on the mechanisms of both beneficial and adverse effects and the pathways of brain 22:6n-3 uptake.

"Assessment of long-chain polyunsaturated fatty acid nutritional supplementation on infant neurobehavioral development and visual acuity." Jacobson, S.W. Lipids, 34(2): 151-160. 1999.
NAL Call Number: QP751.L5
Abstract: None available

"Lipids and infant formulas." Forsyth, J. S. Nutrition Research Reviews, 11(2): 255-278. 1998.
NAL Call Number: QP141.A1N87
Abstract: None available

"Effect of type of early infant feeding on fatty acid composition of plasma lipid classes in full-term infants during the second 6 months of life." Decsi, T., et al. Journal of Pediatric Gastroenterology and Nutrition, 30(5): 547-51. 2000.
NAL Call Number: RJ446.J68
Abstract: BACKGROUND: Previously, the authors found significantly higher arachidonic and docosahexaenoic acid values in plasma lipids in 2-month-old full-term infants fed human milk than in those receiving formula. This is the report of data obtained in full-term infants during the second half of the first year of life. CONCLUSION: Healthy, full-term infants fed formula without preformed dietary long-chain polyunsaturated fatty acids are unable to match the arachidonic and docosahexaenoic acid status of breast-fed infants even during the second half of the first year of life.

"Essential fatty acids and brain development." Gibson, R.A. Proceedings of the Nutrition Society of Australia, 19: 166-171. 1995.
NAL Call Number: QP141.A1N83
Abstract: None available

"Are long-chain polyunsaturated fatty acids essential nutrients in infancy." Makrides, M., et al. Lancet, 345(8963): 1463-1468. 1995.
NAL Call Number: 448.8.L22
Abstract: We investigated whether the disparity in neural maturation between breastfed and formula-fed term infants could be corrected by the addition of fish oil, a source of docosahexaenoic acid (DHA, 22:6 omega 3), to infant formula. Healthy, term infants were randomised at birth to receive either a supplemented or placebo formula If their mothers had chosen to bottle feed. Breastfed term infants were enrolled as a reference group. Infant erythrocyte fatty acids and anthropometry were assessed on day 5 and at 6, 16, and 30 weeks of age. Visual evoked potential (VEP) acuity was determined at 16 and 30 weeks. VEP acuities of breastfed and supplemented-formula-fed infants were better than those of placebo-formula-fed infants at both 16 and 30 weeks of age (p < 0.001 and p < 0.01). Erythrocyte DHA in breastfed and supplemented-formula-fed infants was maintained near birth levels throughout the 30-week study period but fell in placebo-formula-fed infants (p < 0.001). Erythrocyte DHA was the only fatty acid that consistently correlated with VEP acuity in all infants at both ages tested. A continuous supply of DHA may be required to achieve optimum VEP acuity since infants breastfed for short periods (< 16 weeks) had slower development of VEP than infants receiving a continuous supply of DHA from either breastmilk or supplemented formula. Erythrocyte arachidonic acid (20:4 omega 6) in supplemented-formula-fed infants was reduced below that of infants fed breastmilk or placebo formula at 16 and 30 weeks (p < 0.001), although no adverse effects were noted, with growth of all infants being similar. DHA seems to be an essential nutrient for the optimum neural maturation of term infants as assessed by VEP acuity. Whether supplementation of formula-fed infants with DHA has long-term benefits remains to be elucidated.

"Making the public and pediatric community aware of the importance of fatty acids in infant nutrition." Oski, F.A. Nutrition, 12(5): 380-1. 1996.
NAL Call Number: QP141.A1N866
Abstract: None available

HEALTH PROFESSIONAL'S ROLE

"Current parent education on infant feeding in the neonatal intensive care unit: the role of the occupational therapist." Caretto, V., et al. The American Journal of Occupational Therapy, 54(1): 59-64. 2000.
Abstract: OBJECTIVES: The purpose of this study was to describe current trends in parent education on infant feeding in the neonatal intensive care unit (NICU) and to clarify the role of the occupational therapist in educating parents. METHOD: Questionnaires were mailed to 190 neonatologists across the United States who were asked to forward it to a NICU occupational therapist. The questionnaire gathered descriptive information about the structure of parent education in the NICU, the role of the occupational therapist in providing parent education, and demographics about respondents and their NICUs. The response rate was 53% (n = 100). RESULTS: All 100 hospitals responding provided parent education in some form, and most included a variety of topics and teaching methods. Occupational therapists were on the NICU team at 74 of the hospitals and were identified third most frequently as a provider of parent education. The occupational therapists were most frequently identified as responsible for teaching about positioning, infant development, and infant states and cues and were highly involved in educating parents about feeding. CONCLUSION: Current parent education programs in NICUs are comprehensive in scope. Occupational therapists' role in educating parents about infant care and feeding consists of a focus on certain topics where occupational therapists have specialized skills and education. Occupational therapists are recognized by their NICU colleagues as providers of parent education, but this study suggests that the occupational therapists' role may not be clearly understood by other NICU professionals.

"Pediatrician's responsibility for infant nutrition." American Academy of Pediatrics. Committee on Practice and Ambulatory Medicine. Pediatrics, 99(5): 749-50. 1997.
NAL Call Number: RJ1.P42
Abstract: The intent of this policy statement is to reaffirm the position of the American Academy of Pediatrics on four issues pertinent to infant nutrition: the promotion of breastfeeding, the importance of working to maintain and improve infant formulas for use when breastfeeding is not practical or desired, the recommendation against direct-to-consumer advertising of infant formulas, and the encouragement of the availability of a diversity of formulas.

"The clinician's role in teaching proper infant feeding techniques." Lawrence, R. The Journal of Pediatrics, 126(6): S112-S117. 1995.
NAL Call Number: RJ1.A453
Abstract: The species-specific advantages and significant nutritional and health benefits of breast-feeding are widely acknowledged. Less recognized are the advantages of the process of breast-feeding itself. Adherence to the natural mechanics of breast-feeding will preclude many of the problems associated with improper bottle feeding. For example, the semi-upright position of the infant during breast-feeding helps eliminate the entry of milk into the middle ear and reduces choking and regurgitation. The action of suckling during breast-feeding minimizes the intake of air. In addition, the direct eye contact that is natural to breast-feeding fosters bonding, and the close body contact promotes a sense of security in the child. These advantages, so natural to breast-feeding, are likely to be absent from bottle feeding unless some of the natural techniques associated with breast-feeding are adopted. This article describes various aspects of the breast-feeding process with the goal of urging practitioners to instruct patients to transfer these techniques to bottle feeding. In so doing, clinicians may help their patients avoid the hazards of improper bottle feeding.

INFANT FEEDING IN RELATION TO GROWTH AND DEVELOPMENT

"Early infant feeding and growth status of US-born infants and children aged 4-71 mo: Analyses from the third National Health and Nutrition Examination Survey, 1988-1994." Hediger, M.L., et al. The American Journal of Clinical Nutrition, 72(1): 159-67. 2000.
NAL Call Number: 389.8.J824
Abstract: BACKGROUND: There is controversy over what growth references to use in evaluating breast-fed infants and concern about whether never-breast-fed infants are at risk of overweight in childhood. OBJECTIVE: The objective of this study was to determine whether infants who are exclusively breast-fed for 4 mo differ in average size from infants who are fed in other ways and whether such differences persist through age 5 y. DESIGN: Data from the third National Health and Nutrition Examination Survey (NHANES III) were linked to birth certificates of US-born infants and children. Feeding groups were defined on the basis of feeding patterns over the first 4 mo of life: exclusively breast-fed for 4 mo, partially breast-fed, breast-fed for <4 mo, and never breast-fed. Growth status, indexed as internally derived z scores (SD units) for weight, length (height), weight-for-length (height), midupper arm circumference, and triceps skinfold thickness, was compared among feeding groups. RESULTS: The final sample consisted of 5594 non-Hispanic white, non-Hispanic black, and Mexican American infants and children aged 4-71 mo. Of these, 21% were exclusively breast-fed for 4 mo, 10% were partially breast-fed, 24% were breast-fed for <4 mo, and 45% were never breast-fed. At 8-11 mo, infants who were exclusively breast-fed for4 mo had adjusted mean z scores for weight (-0.21; -0.2 kg), weight-for-length (-0.27), and midupper arm circumference (-0.15) that differed significantly from zero (P < 0. 05). By 12-23 mo, the differences had dissipated; there were no significant differences subsequent to 5 y. Triceps skinfold thickness was not related to early infant feeding. CONCLUSION: Infants who were exclusively breast-fed for 4 mo weighed less at 8-11 mo than did infants who were fed in other ways, but there were few other significant differences in growth status through age 5 y associated with early infant feeding.

"The influence of neonatal nutrition on behavioral development: A critical appraisal." Wauben, I.P.M. and Wainwright, P.E. Nutrition Reviews, 57(2): 35-44. 1999.
NAL Call Number: 389.8.N953
Abstract: Specific nutrients appear to modify the metabolism of neurotransmitters, which are endogenous regulators of neurogenesis, neural migration, and synaptogenesis during both embryonic and early postnatal life. This has led to the question of whether, by affecting neurotransmission, malnutrition during the early neonatal period affects behavioral development. The literature based on animal models suggests that nutrient deficiencies during early life influence neurotransmission and, in some instances, also affect behavioral outcomes. A clear answer to the question, however, remains elusive. This can be attributed to the complexity of the process of brain development, where changes at a cellular level may not necessarily translate into changes at a behavioral level. Future investigation in this important area of research should work toward refinement of the design of behavioral experiments so that these studies can contribute to the understanding of the putative mechanisms involved.

"Mode of infant feeding and achieved growth in adolescence: Early feeding patterns in relation to growth and body composition in adolescence." Tulldahl, J., et al. Obesity Research, 7(5): 431-7. 1999.
Abstract: OBJECTIVE: Feeding mode in infancy and differences in childhood growth have been studied in several longitudinal studies, but few studies have followed children up to adolescent age. There is evidence that formula-fed infants weigh more and are taller than their breast-fed counterparts, and indications that this difference may sustain. RESEARCH METHODS AND PROCEDURES: We have studied the relations between length of breast-feeding, growth, and body composition in a group of 781 representatively chosen adolescents. Data on feeding pattern in infancy and on weight and height from birth up to 18 years were collected. We studied the relation between high body mass index (BMI) (defined as < or =85th percentile) in adolescence and length of breast-feeding. RESULTS: Girls who were not breast-fed or breast-fed for less than 3 months had a significantly higher height curve than girls exclusively breast-fed for more then 3 months. There were tendencies towards higher values of adipose tissue measured by skinfolds in girls breast-fed for 3 months or less. Short duration of exclusive breast-feeding was associated with higher BMI (p<0.04). In a subgroup of 194 adolescents, body composition was measured with dual energy X-ray. Both boys and girls who were exclusively breast-fed for more than 3 months were leaner and showed a trend towards lower skinfold values. CONCLUSION: These results are important to include in the debate about optimal feeding in infancy. Regarding breast-feeding as a standard, our results imply that formula fed infants may be at risk for overfeeding, which might lead to overweight, even up to adolescent age.

"Early flavor experiences: Research update." Mennella, J.A. and Beauchamp, G. K. Nutrition Reviews, 56 (7): 205-211. 1998.
NAL Call Number: 389.8.N953
Abstract: Anyone who has observed infants for any period of time can testify to the intense activity occurring in and around their mouths-the primary site for learning in the first few months of life. Before they are even able to crawl, infants have learned much about their new sensory world. Through recent research we have begun to explore the impact of these early experiences on infants' acceptance of solid foods and how they explore objects in their environment. We have also begun to focus on the sensory experiences of the formula-fed infant, in particular, how their responses to particular formulas, which are extremely unpalatable to older children and adults, change during infancy. This is a relatively new and exciting area of study, with much research yet to be done. It is clear, however, that infants are not passive receptacles for flavored foods. Parents who offer a variety of foods will provide both a nutritious, well-balanced diet, as well as an opportunity for their children's own personal preferences to develop.

"Energy utilization and growth in breast-fed and formula-fed infants measured prospectively during the first year of life." Bruin-de, N.C., et al. The American Journal of Clinical Nutrition, 67(5): 885-896. 1998.
NAL Call Number: 389.8.J824
Abstract: This study is the first to report approximations of energy requirements for male and female breast-fed and formula fed infants based on individual estimates of total daily energy expenditure (TDEE) and energy deposition derived from total body fat (TBF) and fat-free mass (FFM) gain as determined by total-body electrical conductivity. In 46 healthy, full-term infants the effect of greater than or equal to 4 mo of exclusive breast-feeding compared with formula feeding on macronutrient and energy intake, TDEE, energy deposition, and growth were investigated prospectively. Metabolizable energy intake (MEI) was assessed from macronutrient intake by test weighing (MEI-TW) and from the sum of TDEE and energy deposition (MEI-Pred). At 1-2, 2-4, 4-8, and 8-12 mo of age MEI-Pred averaged 431 +/- 38, 393 +/- 33, 372 +/- 33, and 355 +/- 21 kJ(.)kg-1(.)d-1 for boys, and 401 +/- 59, 376 +/- 25, 334 +/- 33, and 326 +/- 17 kJ(.)kg-1(.)d-1 for girls. No significant difference between breast-fed and formula-fed infants was found with respect to weight, length, head circumference, TBF, FFM, and TDEE at all ages, or for gain in length, weight, TBF, and FFM. MEI-TW was significantly different between feeding groups at 1-4 mo of age (formula-fed being greater than breast-fed, P < 0.005). This feeding effect, however, was not significant for MEI-Pred (MJ/d). MEI-TW differed from MEI-Pred only in breast-fed infants at 1-4 mo (P < 0.05 at 2-4 mo). The data from this study indicate that energy requirements in infants are lower than the recommendations in guidelines currently in use.

"Influence of long-chain polyunsaturated fatty acids on infant cognitive function." Willatts, P., et al. Lipids, 33 (10): 973-980. 1998.
NAL Call Number: QP751.L5
Abstract: None available

"The NCHS reference and the growth of breast- and bottle-fed infants." Victora, C.G., et al. Journal of Nutrition, 128(7): 1134-1138. 1998.
Abstract: The current international growth reference, the National Center for Health Statistics (NCHS) reference, is widely used to compare the nutritional status of populations and to assess the growth of individual children throughout the world. Recently, concerns were raised regarding the adequacy of this reference for assessing the growth of breast-fed infants. We used the NCHS reference to evaluate infant growth in one of the most developed areas of Brazil. Infants who were exclusively or predominantly breast-fed for the first 4-6 mo, and partially breast-fed thereafter, grew more rapidly than the NCHS reference in weight and length during the first 3 mo, but appeared to falter thereafter. The average growth of all infants, regardless of feeding pattern, was faster than the NCHS reference until approximately 6 mo, after which their growth became slower than that of the NCHS sample. To substantiate this finding, the NCHS growth curves were then compared with growth data of breast-fed infants in developed countries from pooled published studies, formula-fed North American and European infants and predominantly bottle-fed U.S. infants monitored by the Centers for Disease Control and Prevention (CDC) Pediatric Surveillance System. In all three cases, weights showed the same pattern as the Brazilian infants--higher than NCHS in the early months but an apparent decline thereafter. The pattern for length gain was similar but less marked. Breast-fed infants showed more pronounced declines than those who were predominantly bottle-fed. These findings suggest that the infancy portion of the NCHS reference does not adequately reflect the growth of either breast-fed or artificially fed infants. This probably results from characteristics of the original sample and from inadequate curve-fitting procedures. The development of an improved international growth reference that reflects the normal infant growth pattern is indicated.

"Human milk protein does not limit growth of breast-fed infants." Motil, K. J., et al. Journal of Pediatric Gastroenterology and Nutrition, 24(1):10-17. 1997.
NAL Call Number: RJ446.J68
Abstract: Background: The efficiency with which breast- and formula-fed infants utilize dietary nutrients is likely to provide insight into their relative requirements for the growth process. Methods: We measured longitudinal changes in growth, body composition, and dietary intakes in breast-and formula-fed infants and estimated the gross efficiency with which dietary nitrogen and energy were used for lean body mass and body fat deposition. Lean bodymass and body fat were determined in 10 breast-fed and 10 formula-fed infants at 6-week intervals during the first 24 weeks of life by the 18O dilution technique. Dietary nitrogen and energy intakes were determined from the amount of milk and food consumed and the nutrient content of the feedings. The gross efficiency of nutrient utilization was calculated for each infant from the cumulative dietary intake and the change in body composition with time. Results: Length and weight gains and lean body mass and body fat accretion during the first 24 weeks of life were similar between breast- and formula-fed infants despite significantly higher nitrogen and energy intakes of the formula-fed group. The gross efficiency of dietary nitrogen utilization for lean body mass deposition was almost two-fold lower in formula- than in breast-fed infants, whereas the efficiency of dietary energy utilization for lean body mass and body fat deposition was similar between groups. Despite apparent differences in the efficiency of nitrogen utilization there was no association between lean body mass deposition and dietary protein intake, implying that human milk protein does not limit growth quantitatively in breast-fed infants. Conclusions: These differences in nutrient utilization illustrate the biologic adaptability of human infants who are quipped with mechanisms that promote normal growth despite the variability of their nutrient intake.

"Total body electrical conductivity derived measurement of the body composition of breast or formula-fed infants at 12 months." Bellu, R., et al. Nutrition Research, 17(1): 23-29. 1997.
NAL Call Number: QP141.A1N88
Abstract: Recent studies found a difference in body composition determined by skinfold thickness measurements between breast-fed and formula-fed infants in the first year of life. We therefore investigated the body composition of 79 infants at 12 months measured by total body electrical conductivity (TOBEC) and compared with early feeding mode (breast-feeding for at least 6 months versus formula-feeding or breast-feeding or for less than of equal to 2 months). Lower weight, stature and cranial circumference were associated with breast-feeding when the variables were compared using an ANOVA model. The groups did not significantly differ in terms of fat-free mass, but body-fat mass was lower among breast-fed infants. Multiple regression analysis showed a significant correlation between body fat mass and duration of breast-feeding and lower amounts of body fat correlated with a longer period of breast-feeding.

"Early fatty acid supply and mental development." Gibson, R.A. and Makrides, M. Nestle Nutrition Workshop Series, 36:19-33. 1996.
NAL Call Number: RC620.A1N47 v.36
Abstract: This chapter presents findings from a long term clinical investigation of the possibility that docosahexaenoic acid (DHA) status of healthy term infants is related to neural function of the visual pathway. The results confirm that erythrocyte DHA and visual evoked potential acuity of formula-fed infants could be improved to breast-fed infant levels by the addition of a fish oil/evening primrose oil fat blend (containing DHA) to the formula. A review of data from investigations of pre-term infants is also presented.

"Early feeding and the acquisition of flavor preferences." Beauchamp, G.K. and Mennella, J. A. Nestle Nutrition Workshop Series, 36:163-177. 1996.
NAL Call Number: RC620.A1N47 v.36
Abstract: After a brief discussion of the sensations of taste and smell, this chapter considers the early development of responsiveness to flavors in the human fetus, infant, and child. It covers the roles of smell and taste in determining food flavor; development of taste; and early development of olfaction as it relates to food.

"Lipids in infant nutrition and their impact on later development." Lanting, C.I. and Boersma, E.R. Current Opinion in Lipidology, 7(1): 43-7. 1996.
Abstract: Numerous studies on infant nutrition show that breast-feeding has a beneficial effect on growth, morbidity, and neurological and cognitive functioning later in life. Moreover, there are indications that a relationship exists between the diet consumed during early childhood and morbidity in adulthood, such as atherosclerosis and insulin-dependent diabetes mellitus. The mechanism causing this advantageous effect of breast-feeding might be found in the fatty acid composition of human milk. The fatty acid content of formula milk is associated with biochemical parameters, cognitive development, and growth. Further research concentrating on randomized trials of 'fatty acid-enriched' formula milks is needed for the sake of children of mothers who opt for bottle-feeding.

"Dietary fat content and energy density during infancy and childhood; the effect on energy intake and growth." Michaelsen, K. F. and Jorgensen, M. H. European Journal of Clinical Nutrition, 49(7): 467-483. 1995.
NAL Call Number: QP141.A1J68
Abstract: None available

"Infant feeding and mental and motor development at 18 months of age in first born singletons." Florey, C. D., et al. International Journal of Epidemiology, 24 Suppl 1: S21-6. 1995.
Abstract: OBJECTIVE. To determine the relationship between type of infant feeding and mental and psychomotor development at age 18 months. METHOD. A follow-up study of children born to primigravidae living in Dundee and booked into antenatal clinics in the City of Dundee (Local Authority District) from 1 May 1985 to 30 April 1986. The study population was 846 first born singletons, of whom 592 attended for developmental assessment at age 18 months. The main outcome measures were the Bayley Scales of Infant Mental and Motor Development. RESULTS. Higher mental development was significantly related to breast feeding on discharge from hospital and according to the health visitors' notes at about 2 weeks after discharge after allowing for partner's social class, mother's education, height, alcohol and cigarette consumption; placental weight and the child's sex, birth weight and gestational age at birth. After adjustment for statistically significant variables, the difference in Bayley mental development index between breast and bottle fed infants was between 3.7 and 5.7 units depending on the source of feeding data. No differences were found for psychomotor development or behaviour. CONCLUSION. The study provides further evidence of a robust statistical association between type of feeding and child intelligence. However, the literature is replete with suggestions for potential confounding variables which offer alternative causal explanations. To unravel what is an important clinical and public health question, further research should concentrate on randomized trials of supplemented formula feeds for children of mothers opting for bottle feeding and on epidemiological studies designed to disentangle the relation between method of feeding, parental intelligence and social environment.

NUTRIENT AND ENERGY INTAKE

"Energy intake, not energy output, is a determinant of body size in infants." Stunkard, A. J., et al. The American Journal of Clinical Nutrition, 69(3): 524-530. 1999.
NAL Call Number: 389.8.J824
Abstract: Background: It has been proposed that the primary determinants of body weight at 1 y of age are genetic background, as represented by parental obesity, and low total energy expenditure. Objective: The objective was to determine the relative contributions of genetic background and energy intake and expenditure as determinants of body weight at 1 y of age. Design: Forty infants of obese and 38 infants of lean mothers, half boys and half girls, were assessed at 3 mo of age for 10 risk factors for obesity: sex, risk group (obese or nonobese mothers), maternal and paternal body mass index, body weight, feeding mode (breast, bottle, or both), 3-d energy intake, nutritive sucking behavior during a test meal, total energy expenditure, sleeping energy expenditure, and interactions among them. Results: The only difference between risk groups at baseline was that the high-risk group sucked more vigorously during the test meal. Four measures accounted for 62% of the variability in weight at 12 mo: 3-mo weight (41%, P = 0.0001), nutritive sucking behavior (9%, P = 0.0002), 3-d food intake (8%. P = 0.0002), and male sex (3%, P = 0.05). Food intake and sucking behavior at 3 mo accounted for similar amounts of variability in weight-for-length, body fat, fat-free mass, and skinfold thickness at 12 mo. Contrary to expectations, neither total nor sleeping energy expenditure at 3 mo nor maternal obesity contributed to measures of body size at 12 mo. Conclusions: Energy intake contributes significantly to measures of body weight and composition at 1 y of age; parental obesity and energy expenditure do not.

"Aspects of mineral bioavailability in infant nutrition." Kaup, S. M. International Dairy Journal, 8(5/6): 435-441. 1998.
NAL Call Number: SF221.I57
Abstract: None available

"Longitudinal study of nutrient and food intakes of infants aged 2 to 24 months." Skinner, J. D., et al. Journal of The American Dietetic Association, 97(5): 495-504. 1997.
NAL Call Number: 389.8 Am34
Abstract: Objective: To determine the nutrient and food intakes of healthy, white infants from families of middle and upper socioeconomic status and to compare intakes to current recommendations. Design: Using an incomplete random block design, we interviewed 98 mother-infant pairs longitudinally when infants were 2, 3, 4, 6, 8, 10, 12, 16, 20, and 24 months old. Data obtained included 24-hour dietary recalls, usual food intake, and food likes and dislikes. Setting: Interviews were conducted in the mother's home by registered dietitians. Subjects resided in two urban areas of Tennessee. Subjects: Of the original 98 subjects, 94 completed the 2-year study. Results: Mean energy and nutrient intakes generally met or exceeded the Recommended Dietary Allowance (RDA). Exceptions were zinc and vitamin D, which were each below 100% of the RDA at 9 of the 10 data points, and vitamin E, which was below the RDA in the infants' second year. Fat intake decreased from more than 40% of energy in the first 6 months to 30% to 32% from 10 to 24 months. One third of the infants drank reduced-fat milks at 12 months and more than half drank them at 24 months. Although infants ate a variety of foods, vegetables often were the least favorite foods. A variety of dairy products provided calcium for the infant but lacked vitamin D. Conclusions: Several nutritional issues about infant feeding before 2 years of age arose. Low intakes of zinc, vitamin D, and vitamin E were observed. In the second year, low fat intake, use of reduced-fat milks, and dislike of vegetables were areas of concern.

"Copper in infant nutrition: safety of World Health Organization provisional guideline value for copper content of drinking water." Olivares, M., et al. Journal of Pediatric Gastroenterolgy and Nutrition, 26(3): 251-257. 1998.
NAL Call Number: RJ446.J68
Abstract: None available

"Amino acid composition of cow's milk and human requirements." O'Conner, D. L. Milk Composition, Production and Biotechnology, Biotechnology in Agriculture Series, Number 18: 203-213. 1997.
NAL Call Number: S494.5.B563B554 no.18
Abstract: None available

"Vitamin requirements for term infants: considerations for infant formulae." Powers, H.J., et al. Nutrition Research Reviews, 10: 1-33. 1997.
NAL Call Number: QP141.A1N87
Abstract: None available

"Should the current recommendations for energy intake in infants and young children be lowered." Cryan, J. and Johnson, R.K. Nutrition Today, 32(2): 69-74. 1997.
NAL Call Number: RA784.N8
Abstract: As the United States Food and Nutrition Board gears up to revise the Recommended Dietary Allowances, one of their most fundamental considerations will be whether to lower the current recommendations for energy intake for infants and young children. The data on which it will base its decision come from studies using the relatively new doubly labeled water technique.

"Haem iron intake in 12-36 month old children depleted in iron: Case-control study." Mira, M., et al. BMJ: British Medical Journal International, 312(7035): 881-883. 1996.
NAL Call Number: R31.B55
Abstract: Objective: To compare the intakes of haem and non-haem iron in iron depleted and iron replete children. Design: Case-control study. Setting: Early Childhood Centres and a long day care centre in Sydney, Australia. Subjects: Children aged 12-36 months depleted in iron and controls matched for age and sex. Mean outcome measures: Iron status by using plasma ferritin concentration. A three day weighed dietary intake record completed by the parents. Risk factors for iron deficiency assessed by questionnaire. Results: Fifty six iron depleted and 68 iron replete children participated. The average daily intake of haem iron was significantly lower in the iron depleted group (t=2.392, P=0.018); there was a tendency towards a lower average daily intake of non-haem iron (t=1.724, P=0.086) and vitamin C (t=1.921, P=0.057) for iron depleted children. Low intake of haem iron (< 0.71 mg/day) was significantly associated with iron depletion with an odds ratio of 3.0 (P=0.005). The proportion of iron depleted children who were given whole cows' milk before 12 months of age was almost double that of iron replete children; multivariate analysis showed that both haem iron intake and age of introduction of cows' milk were independently associated with iron depletion. Conclusions: The results of this study show that, in young children in developed countries, a lower haem iron intake is a major risk factor for iron depletion; the introduction of whole cows' milk before 12 months is further confirmed as a risk factor. Parental education on nutrition should now focus on these two aspects of nutrition for infants and young children.

"Assessing the vitamin A and carotenoid intake of infants." Groh, W. S. Topics in Clinical Nutrition, 11(3): 27-37. 1996.
NAL Call Number: RM214.T66
Abstract: Vitamin A consists of a group of compounds that includes preformed vitamin A as well as provitamin A carotenoids and is usually expressed in retinol equivalents (RE). Interconversion of various units of vitamin A and interpretation of food labels and composition tables can be confusing. Excellent sources of vitamin A for infants include human milk, infant formulas, and carotene-rich fruits and vegetables. A benign condition called carotenemia is common in infancy. Several specific conditions place infants at risk for vitamin A deficiency. Toxicity is most often associated with inappropriate use of supplements or liver. Well-planned infant diets provide safe yet adequate intakes of vitamin A.

OBESITY AND EATING BEHAVIORS

"Risk factors for the emergence of childhood eating disturbances: A five-year prospective study." Stice, E., et al. International Journal of Eating Disorders, 25(4): 375-387. 1999.
NAL Call Number: RA784.A1I5
Abstract: Objective: Research suggests that eating problems are often present by preadolescence, yet little is known about the age of emergence of these early eating disturbances or risk factors for these behaviors. Thus, we investigated the timing of onset of disturbed eating during childhood and the predictors of these behaviors. Method: These aims were addressed by following a sample of children and their parents (N = 216) for the first 5 years of the childrens' lives. Results: Data suggested that the risk for emergence of inhibited eating, secretive eating, overeating, and vomiting increased annually through age 5. Maternal body dissatisfaction, internalization of the thin-ideal, dieting, bulimic symptoms, and maternal and paternal body mass prospectively predicted the emergence of childhood eating disturbances. Infant feeding behavior and body mass during the first month of life also predicted the emergence of these behaviors. Discussion: Results suggest that eating disturbances emerge during childhood and may be a function of certain parental and child characteristics.

"Early feeding and obesity." Poskitt, E.M. Nestle Nutrition Workshop Series, 36: 179-191. 1996.
NAL Call Number: RC620.A1N47 v.36
Abstract: In this review of early feeding and obesity, the author discusses: 1) the fat babies epidemic; 2) breast vs. formula feeding in relation to infant obesity (content of feeds); 3) style of infant feeding; 4) adipose cell hypothesis of obesity; 5) Does obesity in infancy predispose to later obesity? 6) Do weaning practices influence later obesity? and 7) Are there other ways in which early nutrition could influence obesity later.

WEANING FOODS

"Weaning: when and what." Morgan, J. BNF Nutrition Bulletin, 23(suppl.1): 35-45. 1998.
NAL Call Number: TX341.B75
Abstract: None available

"Transitions in infant feeding during the first year of life." Skinner, J. D. Journal of the American College of Nutrition, 16(3): 209-215. 1997.
NAL Call Number: RC620.A1J6
Abstract: Objective: To document ages at which transitions in infant feeding occur, to compare these transitions to literature reports from the 1970s and 80s, and to identify maternal characteristics related to the age of the infant when solid food was first introduced. Methods: Ninety-eight mother/infant pairs (middle and upper socioeconomic status) participated in the longitudinal study. Using a randomized, incomplete block design, in-home interviews were conducted by trained personnel when infants were 2, 3, 4, 6, 8, 10, and 12 months of age; each mother/infant pair was seen four or five times. Information on food intake, including breast milk/formula, was collected at each interview. Means +/- SD and frequencies were calculated, and least squares analysis of variance was used to develop a predictive model related to the introduction of cereal. Results: Most mothers decided on the initial feeding mode (breastfeeding or formula) prior to pregnancy; 83% breastfed initially although most (76%) totally discontinued breastfeeding by 6 months. Infants' ages varied greatly when each of the seven categories of food was introduced; cereal was added to the infants' diets at a mean age of 3.8 +/- 1.4 (SD) months, juice 4.7 +/- 2.2. fruit 4.9 +/- 1.6, vegetables 5.2 +/- 1.3, mixed foods 7.8 +/- 2.1, table foods 8.2 +/- 2.1, and meat 8.2 +/- 2.1. The multivariate model explained 59% of the variability in ages of infants when cereal (generally the first solid food) was added. Significant variables (p less than or equal to 0.05) were feeding mode, recommendation by the physician, and the interaction between feeding mode and education of the mother. Mother's employment and sibling rank of the infant contributed to the model (p = 0.06 and p = 0.09, respectively). Infants' age when cereal was added was not related to the variables of gender or birth weight. Conclusions: The finding that the mothers' decision whether or not to breastfeed was made prior to conception supports the importance of population-based education aimed at women in the child-bearing years as well as patient instruction early in the pregnancy. However, the duration of breastfeeding was shorter than was reported in the 1980s. Infants varied greatly in ages when the seven categories of complementary foods were added to their diets. Although recommendations for delaying introduction of solid foods until the infant is 4 to 6 months of age have been in place for more than a decade, about half the mothers in this study did so earlier. Characteristics of mothers who introduced cereal earliest (i.e., mean age of infants <4 months) were more likely to be formula feeding when cereal was added, to feed cereal via the bottle, to be primiparous, to be employed outside the home, and/or not to cite the physician as a source for guiding the infant's transition to supplemental food.

"Dietary fiber in weaning cereals: a study of the effect on stool characteristics and absorption of energy, nitrogen, and minerals in healthy infants." Davidsson, L.L., et al. Journal of Pediatric Gastroenterology and Nutrition, 22(2): 167-179. 1996.
NAL Call Number: RJ446.J68
Abstract: We evaluated the effect of increased dietary fiber (DF) content in weaning cereals based on wheat/soy (8.0 and 1.8% DF) and wheat/milk (5.3 and 2.0% DF) in healthy, formula-fed infants 7-17 weeks old. The study had a cross-over design, each infant acting as his or her own control. Stool characteristics and anthropometry were monitored over 4-week periods in groups of 34 (wheat/soy) and 23 (wheat/milk) infants. Absorption of zinc (Zn) and calcium (Ca) was studied by measuring the fecal excretion of stable isotopes during 72 h (70Zn and 42Ca) in a subgroup of the infants consuming wheat/soy cereals. Iron (Fe) bioavailability was evaluated by analysis of the incorporation of 58Fe into erythrocytes 14 days after administration. Fractional absorption (X +/- SD: 8.0 versus 1.8% DF) was 45.3 +/- 27.5 versus 41.2 +/- 19.4% of 70Zn and 63.4 +/- 15.8 versus 64.4 +/- 10.6% of 42Ca. Bioavailability of 58Fe varied between 1.0% and 5.4% (8.0% DF) and from <0.9% to 9.1% (1.8% DF). No significant difference in energy (95.3 +/- 2.0% versus 95.7 +/- 1.2%) or nitrogen (92.6 +/- 2.3% versus 93.0 +/- 1.6%) apparent absorption from the total diet was found during consumption of cereal with 8.0 and 1.8% DF. The intake of cereal decreased with higher DF content in the wheat/soy product: 34 +/- 23 g/d (8.0% DF) versus 42 +/- 23 g/d (1.8% DF), p < 0.01. While consuming the 8.0% DF product, 11 infants were reported to have "gritty stools"; no other differences were observed between different groups in stool characteristics or anthropometry. These results demonstrate no negative effect on the absorption of energy and nutrients with higher dietary fiber intake in primarily formula-fed infants. The impact of increased dietary fiber levels remains unknown in less well-nourished infants.

"Weaning foods--the role of fruit juice in the diets of infants and children." Lifshitz, F. Journal of the American College of Nutrition, 15(5,suppl.): 1S-3S. 1996.
NAL Call Number: RC620.A1J6
Abstract: None available

"Cereal feeding and its impact on the nitrogen economy of the infant." Shulman, R.J. The American Journal of Clinical Nutrition, 62(5): 969-972. 1995.
NAL Call Number: 389.8.J824
Abstract: To quantify the effect of rice cereal on nitrogen balance and fecal nitrogen excretion, and the contribution of endogenous nitrogen sources to fecal nitrogen output, nine infants aged 3-5 mo received [15N]glycine in all feedings. Samples of urine and feces were obtained daily and analyzed for nitrogen and 15N. On days 1-7 the infants received only formula, and a complete urine and fecal collection was made on days 6-7. From days 8 to 12 the formula was supplemented with rice cereal (133.3 g/L, or 4 g/30 mL formula) and a second complete urine and fecal collection was made on days 11-12. Cereal did not alter fecal nitrogen output or the calculated contribution (45%) of endogenous nitrogen to fecal nitrogen. Cereal did increase nitrogen retention and lower the urinary excretion of the 15N dose (24% of dose). The calculated true digestibility of the rice cereal protein was > 95%. Our results indicate that infants aged 4 mo, in contrast with younger infants, are able to digest and absorb cereal. The addition of cereal to the diet does not lead to increased fecal protein losses.

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Acknowledgment is given to the following FNIC reviewers:
Janice K. Schneider, MS, RD, Nutrition Information Specialist
Doris Kuehn, MS, RD, Nutrition Information Specialist
This resource list was compiled by:
Mary C. Herrup, RD, Nutrition Information Specialist
This publication was developed through a Cooperative Agreement between the Food and Nutrition Information Center and the Department of Nutrition and Food Science in the College of Agriculture and Natural Resources at the University of Maryland.

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