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Associations Among Feeding Behaviors During Infancy and Child Illness at Two Years

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Abstract

Objectives To explore the different combinations of early feeding practices and their association with child illness in toddlerhood (i.e., asthma, respiratory infections, gastrointestinal infections, and ear infections). Methods The Early Child Longitudinal Study-Birth Cohort (ECLS-B) offers a unique opportunity to address this issue, as the study features a nationally representative sample of children and includes important questions on early feeding behaviors as well as an extensive list of background characteristics on the families. Using a subsample of approximately 7,900 children from the ECLS-B, data from the 9 month and 2 year collections were analyzed to define the occurrence of three feeding practices during infancy (i.e., by age 6 months) identify the key combinations of these practices, and examine associations between these combinations and child illness via logistic regression. Results Results indicate that 70% of parents initiated breastfeeding, 78% introduced formula and/or solid food before 6 months, 74% introduced solid food, and 15% introduced finger foods before 6 months. The most frequent feeding combinations were: breast milk with formula and solid/finger food (36%), formula with solid/finger food (24%), breast milk with formula (11%), breast milk with solid/finger food (14%), exclusive breast milk (8%), and exclusive formula (7%). After controlling for key demographic and family characteristics, results indicated that children who were exclusively breastfed were less likely to experience respiratory or ear infections than those experiencing other feeding combinations. No differences were found in rates of asthma or gastrointestinal infections. Conclusions This study provides insights for parents, medical professionals, and policy makers on the typical feeding practices and best practices for positive health outcomes in early childhood.

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Notes

  1. These waves of data collection are typically called the “9 month data” and “2 year data” although the children’s age ranged from 6 to 22  months for the 9 month data and 16–38 months for the 2 year data.

  2. Those given cow’s milk or fed a combination of foods that did not include breast milk or formula during the first 6 months were excluded because the groups were too small to include in analyses.

  3. Data sources are noted as follows: Parent Interview (PI); Birth Certificate (BC).

  4. Scoring instructions and score value cut-offs were adapted from those presented in the ECLS-B 9 month Users Manual [32]. For the current study those with a score of four or higher were classified as depressed.

  5. An ECLS-B composite variable.

  6. Smoking and alcohol consumption during pregnancy was from birth certificate data and may be underreported [33]. Therefore, this variable may be underestimating the frequency of prenatal risk.

  7. Food insecurity was assessed using 18 responses from the 9 month parent interview. The Household Food Security was scored in accordance with the standard methods described in Guide to Measuring Household Food Security, Revised 2000 from the U.S. Department of Agriculture, Food and Nutrition Service and included as a composite variable by ECLS-B analysts. The composite variable has three categories: (1) food secure, (2) food insecure without hunger, and (3) food insecure with hunger. However, for the purposes of the current analyses, the two food insecure categories were combined making the variable dichotomous (reference group was food insecure households; [33].

  8. From this point forward this category will simply be referred to as “solid food”. The finger food and solid food categories were combined into one to reduce the total number of feeding combination possibilities derived to answer the second research question.

  9. These variables are listed under the measures section and in Table 1. Alternative models were tested including poverty, maternal employment before 6 months of age, smoking in household at 9 months, and maternal use of alcohol at 9 months. Multicollinearity or concerns for redundancy between poverty and WIC participation and between maternal employment and child care usage led to the exclusion of the former variables in each comparison, with minimal impact on the coefficients in the model. Other constructs were removed to increase parsimony (i.e., control variable did not significantly predict any of the four outcomes) unless they were considered theoretically important or to control for precision (e.g., maternal depression).

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Acknowledgments

The authors would like to acknowledge the Virginia and Leonard Marx Foundation, which provides support to the National Center for Children and Families. Earlier findings, on which this article is based, were first presented at the 2007 NICHD-NCES Early Childhood Longitudinal Study, Birth Cohort (ECLS-B) Conference: Development from Birth through Age Two.

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Correspondence to Nina M. Philipsen Hetzner.

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Hetzner, N.M.P., Razza, R.A., Malone, L.M. et al. Associations Among Feeding Behaviors During Infancy and Child Illness at Two Years. Matern Child Health J 13, 795–805 (2009). https://doi.org/10.1007/s10995-008-0401-x

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