OBJECTIVES. Our goal was to determine why women stop breastfeeding at various times during their infant's first year.METHODS. We analyzed self-reported data from 1323 mothers who participated in the Infant Feeding Practice Study II. Mail questionnaires were sent to mothers ϳ2, 3,4,5,6,7,9,10 1 ⁄2 , and 12 months after their child's birth, in which they were asked to rate the importance of 32 reasons for their decision to stop breastfeeding. We applied exploratory factorial analysis to extract meaningful constructs of mothers' responses to the 32 reasons. We then compared the percentages of mothers who indicated that each reason was important in their decision to stop breastfeeding among various weaning ages and used multiple logistic regression models to examine sociodemographic differences in the most frequently cited reasons for stopping breastfeeding.RESULTS. The perception that their infant was not satisfied by breast milk alone was cited consistently as 1 of the top 3 reasons in the mothers' decision to stop breastfeeding regardless of weaning age (43.5%-55.6%) and was even more frequent among Hispanic mothers and mothers with annual household incomes of Ͻ350% of the federal poverty level. Mothers' concerns about lactation and nutrition issues were the most frequently cited reasons for stopping breastfeeding during the first 2 months. Starting from the third month, self-weaning reasons were increasingly cited as important, with the statements "My baby began to bite" (31.7%), "My baby lost interest in nursing or began to wean himself or herself" (47.3%), and "Breast milk alone did not satisfy my baby" (43.5%) cited as the top 3 reasons at Ն9 months of age.CONCLUSIONS. Our findings about the major reasons why mothers stop breastfeeding at various times during their child's first year should be useful to health professionals when attempting to help mothers overcome breastfeeding barriers and to health officials attempting to devise targeted breastfeeding interventions on those issues prominent for each infant age. Pediatrics 2008;122:S69-S76 T HE SIGNIFICANT BENEFITS of breastfeeding for children, mothers, and society are widely recognized. A series of studies conducted in industrialized countries has shown that children who are not breastfed for at least 6 months are 3.5 times more likely than those who are to be hospitalized for respiratory infections such as pneumonia or asthma, 1-6 2 times more likely to suffer from diarrhea, 1,2,7,8 1.6 times more likely to suffer from ear infection, 1,7,8,[9][10][11] and 1.5 times more likely to become overweight during childhood. [12][13][14][15][16][17] Because of the numerous benefits of breastfeeding, the American Academy of Pediatrics Section on Breastfeeding recommends that mothers breastfeed exclusively for approximately the first 6 months after their child's birth and continue breastfeeding for at least the first year of their child's life. 18 Despite the many benefits of breastfeeding, the most recent National Immunization Survey indicated that only 55% ...

OBJECTIVE. Our goal is to describe the methods used in the Infant Feeding Practices Study II (IFPS II), a study of infant feeding and care practices throughout the first year of life. Survey topics included breastfeeding, formula and complementary feeding, infant health, breast-pump use, food allergies, sleeping arrangements, mother's employment, and child care arrangements. In addition, mothers' dietary intake was measured prenatally and postnatally.PARTICIPANTS AND METHODS. The IFPS II sample was drawn from a nationally distributed consumer opinion panel of 500 000 households. All questionnaires were administered by mail, 1 prenatally and 10 postpartum. Qualifying criteria were used to achieve the sample goals of mothers of healthy term and late preterm singleton infants. In addition to the questionnaires about the infants, women were sent a diet-assessment questionnaire prenatally and at ϳ4 months after delivery; this questionnaire was also sent to members of a comparison group who were neither pregnant nor postpartum. RESULTS.A sample of 4902 pregnant women began the study, and ϳ2000 continued through their infant's first year. Response rates ranged from 63% to 87% for the different questionnaires. Compared with adult mothers of singletons from the nationally representative sample of the National Survey of Family Growth, IFPS II participants had a higher mean education level; were older; were more likely to be middle income, white, and employed; were less likely to smoke; and had fewer other children. Compared with women who participated in the National Immunization Survey who gave birth in 2004, IFPS II mothers were more likely to breastfeed and to breastfeed longer. CONCLUSIONS.The IFPS II provides a valuable database because of its large sample size, the frequency of its questionnaires, and its wide coverage of issues salient to infant feeding. Pediatrics 2008;122:S28-S35 T HE INFANT FEEDING Practices Study II (IFPS II) is a longitudinal study of women from late pregnancy through their infant's first year of life. It is a follow-up to the IFPS I, conducted by the US Food and Drug Administration (FDA) in 1992-1993, which provided detailed information about general infant feeding patterns and infant health. [1][2][3][4][5][6][7][8][9][10][11][12][13] In the approximate decade since the original study, there have been significant changes in the products, policies, information, and education related to infant feeding choices. For example, breast pumps have become more effective and more affordable for individuals, new ingredients have been added to infant formula, changes in state and federal laws have reduced the barriers that women face in choosing to breastfeed, and policies and recommendations about infant feeding have changed. In addition, research has more clearly defined the health benefits of breastfeeding for infants in developed countries, 14 and new breastfeeding-promotion campaigns have been conducted.The IFPS II was conducted to better understand the infant feeding practices used by women...

OBJECTIVE. Our goal was to assess the impact of "Baby-Friendly" hospital practices and other maternity-care practices experienced by mothers on breastfeeding duration.METHODS. This analysis of the Infant Feeding Practices Study II focused on mothers who initiated breastfeeding and intended prenatally to breastfeed for Ͼ2 months, with complete data on all variables (n ϭ 1907). Predictor variables included indicators of 6 "Baby-Friendly" practices (breastfeeding initiation within 1 hour of birth, giving only breast milk, rooming in, breastfeeding on demand, no pacifiers, fostering breastfeeding support groups) along with several other maternity-care practices. The main outcome measure was breastfeeding termination before 6 weeks.RESULTS. Only 8.1% of the mothers experienced all 6 "Baby-Friendly" practices. The practices most consistently associated with breastfeeding beyond 6 weeks were initiation within 1 hour of birth, giving only breast milk, and not using pacifiers. Bringing the infant to the room for feeding at night if not rooming in and not giving pain medications to the mother during delivery were also protective against early breastfeeding termination. Compared with the mothers who experienced all 6 "Baby-Friendly" practices, mothers who experienced none were ϳ13 times more likely to stop breastfeeding early. Additional practices decreased the risk for early termination.CONCLUSIONS. Increased "Baby-Friendly" hospital practices, along with several other maternity-care practices, improve the chances of breastfeeding beyond 6 weeks. The need to work with hospitals to implement these practices continues to exist, as illustrated by the small proportion of mothers who reported experiencing all 6 of the "Baby-Friendly" hospital practices measured in this study. Pediatrics 2008;122:S43-S49 B REASTFEEDING PROVIDES MANY benefits to both infants and mothers, including optimal nutrients for infant growth and development, enhancing infants' immunologic defenses, and facilitating mother-infant attachment and mothers' recovery from childbirth. 1,2 However, despite the known benefits of breastfeeding, a substantial proportion of mothers do not breastfeed their infants or breastfeed for Ͻ6 months postpartum. In 2004, 73.8% of US mothers breastfed during the early postpartum period, and 41.5% continued to breastfeed at 6 months postpartum. 3 Although these findings represent a steady increase over the years in the percentage of women breastfeeding, the data still fall short of the national Healthy People 2010 goals of 75% women breastfeeding during the early postpartum period and 50% breastfeeding 6 months postpartum. 4 Certain maternity-care practices in hospital settings have been shown to promote breastfeeding. In particular, the Baby-Friendly Hospital Initiative, a global movement launched in 1991 by the World Health Organization and the United Nations Children's Fund (UNICEF), has been associated with positive breastfeeding outcomes both nationally and internationally. [5][6][7][8][9] This initiative includes ...

OBJECTIVE. Infancy is a time of rapid transition from a diet of virtually nothing but milk (either breast milk or infant formula) to a varied diet from nearly all food groups being consumed on a daily basis by most infants. Despite various recommendations about infant feeding, little is known about actual patterns of feeding among US infants. This article documents transitions in infant feeding patterns across the first year of life and determinants of key aspects of infant feeding.METHODS. Using data from the Infant Feeding Practices Study II, we analyzed responses to a 7-day food-recall chart that was administered every month. The sample size declined from 2907 at birth to 1782 at 12 months of age.RESULTS. Although 83% of survey respondents initiated breastfeeding, the percentage who breastfed declined rapidly to 50% at 6 months and to 24% at 12 months. Many of the women who breastfed also fed their infants formula; 52% reported that their infants received formula while in the hospital. At 4 months, 40% of the infants had consumed infant cereal, 17% had consumed fruit or vegetable products, and Ͻ1% had consumed meat. Compared with infants who were not fed solid foods at 4 months, those who were fed solid foods were more likely to have discontinued breastfeeding at 6 months (70% vs 34%) and to have been fed fatty or sugary foods at 12 months (75% vs 62%).CONCLUSIONS. Supplementing breast milk with infant formula while infants were still in the hospital was very common. Despite recommendations that complementary foods not be introduced to infants aged 4 months or younger, almost half of the infants in this study had consumed solid foods by the age of 4 months. This early introduction of complementary foods was associated with unhealthful subsequent feeding behaviors. Pediatrics 2008;122:S36-S42 T HE AMERICAN ACADEMY of Pediatrics (AAP) recommends that infants be breastfed exclusively for the first several months of life and that breastfeeding should continue through the first year of life. The AAP Committee on Nutrition recommends that infants begin consuming foods in addition to breast milk or formula after 4 months of age, preferably at 6 months of age. 1,2 Early foods should include a source of iron, either fortified infant cereal or meat, but foods high in fat or sugar (eg, sugar-sweetened beverages, French fries, and candy) should not be given to infants. 3 Within these constraints, infants should be introduced to a variety of foods as they transition to table foods. 4 Little is known about current patterns of feeding among US infants during their first year of life. The Feeding Infants and Toddlers Study, a cross-sectional study of US children aged 4 to 24 months conducted in 2002, documented infant and child food intake on the basis of one or two 24-hour recalls but did not collect detailed information on younger infants. 5 In the study described here, we attempted to fill this knowledge gap by assessing milk and formula consumption among a large sample of US infants, as well as changes in their d...

Infants who are bottle-fed in early infancy are more likely to empty the bottle or cup in late infancy than those who are fed directly at the breast. Bottle-feeding, regardless of the type of milk, is distinct from feeding at the breast in its effect on infants' self-regulation of milk intake.