Responsive feeding of infants at breast and with bottle

Rates and predictors of breastfeeding in Canada

Understanding infant feeding in Nova Scotia

Responsive feeding of infants at breast and with bottle

The World Health Organization recommends human milk as the only food for infants for the first 6 months, but less is known about how milk should be fed. Expressing, or pumping, milk and feeding it from a bottle is becoming more commonplace, especially in high-income settings like Canada. Bottle-feeding pumped human milk has long been equated with breastfeeding but there is a body of research showing that how human milk is consumed may have long-term impacts, for instance on an infant’s ability to act upon their feelings hunger and fullness. In this study, we explored three main areas of behaviours, comparing breast- and bottle-feeding human milk, in Nova Scotia.  

Interviews

We conducted a series of interviews at both 6-8 weeks and 20-22 weeks postpartum with caregivers who both breast- and bottle-fed human milk, to explore the practices, challenges, reasons, and enablers of dual modality feeding. We learned that dual modality feeding practices were influenced by a mix of social and material circumstances including breastfeeding challenges, the involvement of support persons, finances, and access to lactation support. Individuals who predominantly fed at the breast expressed milk to address short-term breastfeeding challenges, for convenience under specific circumstances, and to share feeding responsibilities with other caregivers. Individuals who mainly bottle-fed did so due to address longer-term breastfeeding challenges or due to a return to work. We found that dual modality feeding is a unique practice compared to feeding human milk only from the breast or from a bottle alone, so tailored programs and public messaging may be needed to support dual modality feeding families.

Feeding behaviours

There is growing evidence that caregivers behave differently when feeding at the breast compared to a bottle, which may impact their child’s development of hunger and fullness cues and thus their eating behaviours later in life. To explore feeding behaviours, we video-recorded two or three videos of the same infant drinking human milk: mothers breast- and bottle-feeding their infants, and in some cases, another caregiver (e.g. other parent or grandparent) feeding with a bottle. We scores these videos using the Nursing Child Assessment Feeding Scale. We found the most responsive feeding behaviours when mothers were breastfeeding, followed by mothers bottle-feeding, with other caregivers bottle-feeding having the lowest responsive feeding scores. Interestingly, we also saw that infants acted differently: they were more distracted when feeding with a bottle than the breast. To us, this study demonstrates the importance of education regarding responsive bottle feeding for all caregivers in order to encourage healthy growth patterns and eating behaviours.

To learn more, check out the MAMA Lab Learning Hub for infographics on responsive feeding.

Infant growth

We recruited over 100 caregivers in Nova Scotia to participate in a repeated-measures study of infant growth to explore potential differences by predominant feeding style, human milk from the breast only, or mixed human milk feeding with breast and bottle. At 2, 4, and 6 months postpartum we asked caregivers to report their infant weight, length, and head circumference measurements collected during their routine health check-ups, and also asked questions about feeding behaviours, food intake, and other lifestyle and health factors. These data are still being analyzed, and we will report back soon regarding whether feeding modality impacts infant growth over the first 6 months.

This study was funded by researchNS, and conducted in collaboration with researchers at the University of Prince Edward Island, Queen’s University, Acadia University, and the IWK Health Centre.

Rates and predictors of breastfeeding in Canada

Breastfeeding is a top public health priority around the globe, with the World Health Assembly setting a target that 50% of the world’s children under 6 months be exclusively breastfed by the year 2025. While the benefits of, and recommendations around, breastfeeding are well established, breastfeeding rates in Canada remain suboptimal. A 2013 Statistics Canada publication reports that breastfeeding rates differ by geographic region, and are higher among partnered and higher socioeconomic status mothers. These past socioeconomic disparities in breastfeeding outcomes reveal the need for a nuanced, equitable approach to support, protect, and promote breastfeeding in Canada.

In this paper, we present results from the Public Use Microdata Files (PUMFs) from the most recent CCHS-MEX cycle (2017-2018). We present current breastfeeding trends and explore predictors of breastfeeding outcomes at the national and regional levels, providing insights into the state of breastfeeding in Canada, and also zoom in on our home region, Atlantic Canada.

You can read the full paper here:

Learn more about breastfeeding in Atlantic Canada here (click on images to see 3-page PDF):

This research was supported by a Mount Saint Vincent University Social Sciences and Humanities Research Council Exchange Grant (165278), and a Mount Saint Vincent University Aid to Scholarly Publications and Communications Grant (165448).

Understanding infant feeding in Nova Scotia

Our question

This project has been an ongoing effort to explore the culture around infant feeding among the general public in Nova Scotia. In Phase I of this project we wanted to answer two questions:

• What do Nova Scotians know about infant feeding? and

• How confident are they in their knowledge?

We surveyed adults across the province about infant feeding, and then asked participants to self-rate their confidence. We then compared participant responses to government recommendations to see if there were any differences.

Results

A diverse group of 229 adults complete the survey: 60% were women, 73% identified as white, 69% were parents, and participant age ranged from 19 to 95 years. While participants answered some questions correctly, for example 86% correctly answered that breastmilk was the best food for a new infant, we also found several knowledge gaps. In fact, over 50% of participants incorrectly answered 6 out of the 10 questions we analyzed. We also found that infant feeding knowledge varied with certain characteristics. Men, non-parents, older adults, and participants with lower household incomes tended to answer incorrectly more often.

Despite these knowledge gaps, we found that participants were generally quite confident in their infant feeding knowledge. On average, participants’ self-rated confidence was 7.2 out of 10, and for three questions, we found that participants that answered incorrectly were just as confident in their knowledge as participants that answered correctly.

This study shows that there may be low awareness of infant feeding recommendations in Nova Scotia, and this could potentially result in sharing incorrect information. High confidence in incorrect beliefs may also affect adherence to the recommendations.

How to find out more

If you would like to learn more, you can read our peer-reviewed article “High confidence, yet poor knowledge of infant feeding recommendations among adults in Nova Scotia, Canada”. We also reviewed other research on infant feeding knowledge and attitudes in our article “Exploring breastfeeding knowledge and attitudes among non-caregivers: A narrative review”.

You can also see our coverage from The Chronicle Herald, or check out a summary of our research in this short video.

Phase II

Most nutrition education is provided to new parents, but in reality many folks in the general population are apt to provide input and advice on feeding little ones. We conducted a series of focus groups with young, non-parent men to better understand their take on infant feeding. Results coming soon.

Funded by a Mount Saint Vincent University New Scholar’s Grant.

Infant feeding during COVID-19

In April 2020, the MAMA Lab set out to explore what Nova Scotian caregivers of newborns were experiencing during the COVID-19 State of Emergency, and whether the pandemic was changing how or what caregivers were feeding their babies. To do this, we created an online survey which opened one month after the provincial State of Emergency was declared in Nova Scotia. Remembering back to this time, non-emergency healthcare was suspended, public indoor spaces and non-essential businesses were closed, social contact was only allowed within household ‘bubbles’, and even outdoor activities were limited. In the month afterwards, 335 new parents filled out our survey. Participants were nearly all female, white, and generally had high household incomes. Over half of participants were breastfeeding, while 21% were formula-feeding and 19% were feeding both formula and breastmilk.  

Overall, most caregivers didn’t change the way they were feeding their babies due to the pandemic. Some breastfeeding caregivers changed how often they were pumping, but most feeding changes were not pandemic-related, but instead were due to baby’s age or preferences. Many formula-feeding participants had issues with access to infant formula, especially caregivers of babies with dietary restrictions, due to stockouts caused by stockpiling, or due to cost.

Even though caregivers didn’t report changes, they did report many common worries and concerns. Many caregivers, regardless of feeding method, reported feeling unsupported without access to normal programs, health care, and lactation supports, causing concern about their baby’s health, growth, and development. Some formula feeding participants also felt guilt or shame related to feeding formula and were concerned about the supply chain.

On the other hand, some participants also talked about positive changes and experiences related to the pandemic, including more time at home with their baby, more feeding on demand, and more support within their household bubbles. Some were also happy to experience less breastfeeding in public and no visitors at home, creating less pressure from others.

If you are experiencing these changes or these emotions, know that you’re not alone! Click here for some resources that may help you during this time.

Want to read more? The results of this study were published in February 2021: Fry et al 2021 Maternal & Child Nutrition e13154 doi: 10.1111/mcn.13154

You can also read more about the study here:

• Study finds pandemic boosted worries among new moms in N.S. (Stuart Peddle) Halifax Chronicle Herald. April 15, 2021.

• Study looks at how babies have fared during the pandemic (Yvette d'Entremont) Halifax Examiner. April 22, 2021.

• Study highlights impact of state of emergency measures on infant and caregiver wellbeing. Research Nova Scotia, April 7, 2021.

Disordered eating among male bodybuilders

Funded by a Mount Saint Vincent University New Scholar’s Grant.