Infant feeding practices in a diverse group of women: The Healthy Start Study
Authors: Kaar Jill Landsbaugh , Sauder Katherine A , Crume Tessa L , Shapiro Allison L.B. , Starling Anne P , Dabelea Dana 
Published: November 2023

Objective

To describe infant feeding practices among a diverse group of mother‐offspring pairs and identify demographic factors related to adherence to the American Academy of Pediatrics (AAP) recommendations.

Methods

We analyzed data from 942 mother‐offspring pairs in The Healthy Start Study, an ongoing longitudinal pre‐birth cohort in Colorado. Prospectively obtained maternal self‐report of infant feeding practices (breastfeeding, formula feeding, and complementary foods) were ascertained at 4–6 months and 18–24 months postnatally. Mothers were classified according to the following AAP recommendations: 1) exclusive breastfeeding for first 6 months, 2) continued breastfeeding through 12 months, and 3) introduction of complementary foods after 6 months of age. Mothers who met all three recommendations were categorized as “adherent” and all others were categorized as “not adherent”.

Results

Eighty three percent of mothers were not adherent to the AAP guidelines. Of these, 74% did not exclusively breastfeed for the first 6 months, 87% did not continue breastfeeding for 12 months, and 39% introduced complementary foods prior to 6 months. The majority (74%) did not meet two or more of the guidelines (Fig 1). Of the women who did not exclusively breastfeed for 6 months, 75% introduced formula before 3 months of age (Fig 2). The mean age of introduction to complementary foods across the entire cohort was 6 months of age, and the order of introduction of food types was similar (i.e., started with fruits and vegetables at 6 months, at 8–10 months introduced potatoes, dairy products [yogurt, cheese] and meats, and did not offer nuts [including peanut butter], chips, or candy until after 12 months of age).

Compared to adherent mothers, non‐adherent mothers were younger (27.9 vs 31.0 years; p<0.0001), more likely to be of a minority racial or ethnic group (49% versus 16%; p<0.0001), more likely to have a pre‐pregnancy BMI≥30 (21% vs 9%; p=0.001), more likely to be unmarried (21% vs 3%; p<0.0001), and less likely to have a college degree (68% versus 94%; p<0.0001). Non‐adherent mothers were also more likely to receive WIC services (26% vs 13%; p=0.0002), more often reported working full‐time jobs (37% vs 28%; p=0.001), and less likely to report “pumping” breastmilk (64% vs 91%; p<0.0001). The strongest predictors of non‐adherence were working a greater number of hours worked after the baby was born (β= 0.42; p = 0.008) and not pumping breastmilk (β= −0.83; p = 0.001).

Conclusions

We found that a substantial proportion of mothers in a large contemporary cohort are not adhering to AAP guidelines on infant feeding. The AAP guideline that is least likely to be adhered to is the recommendation for 6 months of exclusive breastfeeding. Given this, future research should focus on better understanding the determinants of non‐adherence in order to develop effective intervention strategies to improve infant feeding practices.

Support or Funding Information

NIH R01DK076648; PI: Dabelea