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* W eaning re fe rs to age a t d iscon tinua tion of b reas t o r bo ttle feed ing . (B o ttle w ean ing n o t rep resen ted fo r b reast
fe d s ub je ct s.)
In fan t F eedin g P attern s an d O ra l H a b its 32 7
T A B L E I
Freq uency of B reast F eed in g an d of D em and Feed ing in C h ild ren C las sif ied A cc ord ing to R e lative B ody W eig ht*
P atie n t G ro u p
Overweight
U nde r w e i g ht
N o r m a l w e i g ht
Total
A ll P a t ien ts W h ite P a t ien ts N eg ro P a tie n ts P u e rto R ica n P a tien ts
B r ea st D em a n d B re a st J)ern;nd B r ea st D e m a nd
N o . F ed F e d N o . F e d F e d N o . F e d F ed
(% ) ( 7 0 ) (% ) (% ) (% ) (% )
219 29 2 45 8 34 55 9 48 5 13 61 5 38 5
1 0 8 3 2 .4 5 3 .3 5 4 4 0 .7 3 1 .9 8 2 4 3 .9 5 5 .3
2 6 3 0 .8 2 4 .0 5 40 .0 8 0 .0 8
37. 5
50.0
353 30 3 46 5 93 46 2 52 2 103 45 6 52 11
-:;:::-
N o . F ed
(.4)
267 34 5
2 4 6 3 8 .2
4 0 3 2 .5
553 36 0
D e m a n d
Fe d
(% )
46 2
5 2 . 9
3 5 . 9
48 4
* D em a n d d a ta b a sed o n 5 4 1 pa t ien ts .
appro pria te in th is stud y s in ce 8 1 .2 per cen t o f these T ab les i th roug h v i. In g ene ra l, s ign ifican t d if-
sub jects (82 .6 p er cen t o f overw eigh t and 80 .4 per fe rences, i.e ., a t the 5 per cen t leve l, w ere n o t
cen t o f un derw e igh t c h ild re n) w e re co ntinue d on
observed be tw een overw eig h t and un derw eigh t
th e
breas t fo r a p eriod o f at le ast on e m on th .
pa tien ts in re spec t to in fan t feed ing p rac tice s
Sched u le fed in fan ts w ere th ose fed e ithe r
a d lib itu m
or curren t o ra l a ttribu tes . V aria tion s am on g
or w ith o nly tok en o r inco ns tan t adh ere nce to a n
estab l ish ed rou tine . T he d ura tio n o f b rea st o r o f th e princ ipa l e th n ic g rou ps often w ere g reate r,
if no m ore cons isten t, than tho se be tw een
b o ttle feed in g w as designa ted th ro ugh th at age a t
w hich the ch ild last suck led or drank m ilk fro m the
w eigh t g rou ps. H ow eve r, ove r-a ll b rea st feed -
b ott le ( w ean ing ag e ) . Curren t d aily m ilk con - in g pa tte rns w ere com p arab le to those re -
su m p tion w a s e stim ated to ti le c losest (8 oun ce) ported fo r o ther popu la tions in th is and o ther
cu p . P resen t candy and chew ing
g um con sum ption
w este rn /1
243o
and th e d ata fo r th e
w as cla ssif ied as oc cu rrin g frequ en tly , oc cas ion ally sub group of w hite ch ild ren w ere la rge ly in
or (p rac tica lly ) no t at all. T hu m b-suck ing w as accord w ith tho se fo r the to ta l pa tien t sam ple .
jud ge d to h ave b een pre sen t, i.e . , m e an ingfu l, O ve rw eig h t patien ts con sum ed
break fast
w he n the ha b it p ers iste d thro ugh the firs t y ear . le ss regu la rly than und erw eigh t ch ild ren (65 .0
v ersus 8 5 .8 per cen t, P < 0 .00 01), a d ifferen ce
R E S U L T S
w hich w as a lso no ted in the sam p le of w hite
T he princ ipa l observa tion s a re sum m arized
in
sub jec ts alo ne (63 .3 v ersus 84 .8 per cen t,
P < 0 .0001 ) and even fo r w h ite g irls a lone
A T he b ott le w ean ing pa ttern of tho se su b je cts w h o
w ere bre ast fed in it ia lly w as sim ila r to the pa ttern o f
(60 .6 v ersus 80 .3 per cen t, P < 0 .01). N on -
tho se sub jec ts W h o w ere b ottle fed fro m b irth . w hite ch ild ren in bo th w eigh t g roup s a te b reak-
T A B L E II
W eaning P a tte rn s o f B reas t an d B ottle Fed C hild ren C lassified A ccord in g to R ela tiv e B o th- W eigh t*
Al l Patien ts
B rea st F e d B ottle F ed
P a tien t G ro up
I
W eaned W eaned
N o .
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3 2 8 H ilim an
9
T he f requ en cy o f ex pre sse d p ref eren ce f o r so f t, in c om itrast to hard , c antly w as s ign if ic antly gre ate r P < 0.0 5)
am ison g w h ite than am on g no nw hite childre n .
T A B L E
III
A v erage C urrent M ilk C on sum ption o f C h ild ren
C lass if ie d A c cordin g to R elativ e B od y cight
M ilk In ta k e
Patien t G rou p
N o .
1 .
u p s,
D a y 9
6
I
O v erw eig ht
2 64 2 9.2
6 2. 1 7 .9
0. 8
U nd erw eig ht
24 2
22.3
67.4
7. 8
2. 5
N orm al w e igh t . . .
T o ta l
4 1) 2 5
.
0
5 4 6 2 5 .8
65 . 0
6 4 .7
5
.
0
7. 7
5. 0
1. 8
S tatid ard 8 o u n ce C U J) 1 glass.
f ast m o re reg u larly th an w h ite ch ild ren ( 52 . 6
v ersu s 7 0 .5 p er cen t, P
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* D ifferenc e l im ited to c h ild ren w ith b irth w eig h ts abo ve th e
p remature
leve l of 5 .5 p ou nds show ed P < 0.01 .
In fan t F eed ing Pa tte rns an d O ra l H ab its 3 29
T A B L E V
F requ enc y of P ersiste n t T hu m b -S u cking A m ong C hild re n C lass ifie d A c cord in g to R ela tiv e B o dy \V eigh t an d
A cco rd in g to Infa n t F ee d in g P attern fo r W hite P at ien t S ubg rou p
All Patien ts \V h ite C hild ren
B rea st B o ttle D em an d S ch edu le
P atien t G ro up T hum b- T h un m b - F e d F ed F ed F ed
N o. suc kers N o. su cke rs T hu m b - T hu m b - T hu m b - T hum b-
( ) ( ) su ck ers su cke rs su cke rs suc kers
fC\ { 1 4 9 } fU /\ IC \
c1
I/C l ./
iO
O ve rw eig h t 2 63 24 .3 219 23 .3 2 1 .9 23 .9 26 .5 20 .7
U nd erw eigh t 2 42 20 .7 10 8 20 .4 2 2 .9 19 .2 1 7 .9 22 .4
No r ma l we i g h t 4 0 1 5 . 0 2 6 2 3 . 1 2 5 . 1 2 2 . 2 5 0 . 0 1 5 . 8
T ota l 54 5 21 .7 353 22 .4 22 .4 22 .4 24 .4 20 .7
* T h rou gh firs t ye ar.
larg e r, separa te g rou p of w ell no urished ch il- T hese o bserv ations , even th ough and per-
d ren w ou ld h ave b een des irab le . A lth ough haps because , they are inconc lus ive , m ay
overw eig h t an d und erw eigh t sub jec ts com prise se rv e to em phas ize d ifficu lties encou n tered in
h ysica lly an tithe tic sam p les , bo th rep resen t a ttem p ts to id en tify spec ific d eve lo pm enta l
fo rm s o f m a lnu trit ion w h ich , m an ife sted in ac- facto rs-apa rt from e nergy b ala nce as su ch-
cordance w ith cons titu tiona l and env iron - invo lv ed in the pa thogenes is o f abno rm al body
m ental de term in an ts , m ay w ell have com m on w eig h t pa tte rns . H op efu lly , they m ay a lso
ca use s. A pro spec tive stud y , inv o lv ing ch il- und erscore th e need fo r m ore ob jec tiv e ev i-
d ren from schoo l o r o ther nonc lin ic so urces, d eu ce w h en ever in fan t feed ing prac tices a re
m igh t have grea te r va lid ity althou gh here too , im plica ted in th e cau se of o besity .
sus ta in ed un ifo rm ity of m anag em ent cou ld
scarce ly be in su red a t the exp en se of in te r- SU M M A R Y
curren t, ind iv id ua l hea lth n eed s. Idea lly , In fan t feed ing pa tte rns an d re la ted o ra l
standard s su itab le fo r the nu tritio na l assess- a ttribu tes
w ere stu d ied in ove rw e igh t an d
m e n t of he te ro geneous pop u la tion s a lso sho u ld u nedrw eigh t ch ild ren a tten d ing a p ub lic hea lth
be ava ilab le to im p rove on th is and sim ilar n u trition c lin ic .
stud ies w here in th e com m on h eresy of equa ting O v erw eigh t an d u nderw eig h t ch ild ren d id
overw eig h t and o besity is com po unded by no t d iffe r sign ifican tly in respec t to the fo llo w -
ques tion ab le ex trapo la tio ns from norm s d e- in g : (1 ) the frequency of b reas t feed in g or de-
rived from a s in g le e thn ic g roup .3 in an d feed ing ; (2 ) age o f w ean in g ; (3 ) m ilk ,
T A B L E V I
M ean B irth W e igh ts o f C hild re n C la ssified A c co rd in g to R ela tive B o dy W eig h t by E th n ic G ro up
O v erw eigh t U nd erw eigh t
. -- - - -- -- Difference
P atie n t G ro up . . .
W e igh t l ,k e igh t P ro bab illtv
N o . (lb .) N o . ( lb .)
W h ite m a le 84 7 .
4 9 3 5 6
. 7 8 < 0 . 05 *
W hite f em ale 129 7
.
1 9 7 0 6
.
8 4 0 .05
N o nw hite fem ale 32 7 . 1 4 7 0 6 .
1 0
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33 0
Hil lma n
can d y an d ch ew in g g u m c o n s u mp t i o mi ; o r (4 )
persistence o f thum b-suck in g .
In f an t f eed in g p atte rn s in so m e in s tan ces
ap p eared m o re c lo sely re lated to e th n ic g ro u p
th an to b o d y w e ig h t statu s d u rin g ch ild h o o d .
D if f eren ces b etw een o v erw e ig h t an d u n d er-
w eig h t ch ild ren w ere su g g es ted in re sp ec t to
b reak f ast eatin g h ab its , b irth w e ig h t am id b irth
ran k b ut no t to m o nth to b irth .
R E F E R E N C E S
1. S E N N , M . J. E . In f luen ce of psy cho log ical f acto rs
oil
th e
nu trit ion of ch ild ren . A,,,, J. P ub. H ealth,
35:211 1945.
2. (a)
BRU cH
H . T he Im portan ce o f O v erw eight .
N e w Y ork , 195 7. W .
W .
Nor ton .
(b) B R U cH , H . O be sity . P ediat. Cl in. No rth
America, 5:613 1958.
;3. (a ) SA LBER E. J. , S T I T T P. G . an d BABBOTT J. G .
Patte rns of breas t f ee din g .
I.
Facto rs af fec ting
th e f re qu enc y of breas t f e eding in the ne w bo rn
per iod . New England J. Med., 2 59 : 7 0 7, 1 95 8.
(b) S A L B E R , E . J. , S T I T T P. G . and BABBOTT J. G .
Patterns
I)f
bre ast f eed ing
in a
f am ily cl in ic . ii.
D u ration of f e eding an d re aso ns f or w eanin g .
Ne w Engla nd J. Me d., 26 0: 31 0, 195 9.
4. (a ) B R O W N , F. . L I E B E R M A N ,
J. ,
WIN S TON
J. an d
1L E S H E T T E N. S tud ies in c hoice of in f ant f ee d-
in g by p rin hip arac. I. A tt itud inal f acto rs and
e x traneo us in f lue nce s.
P syc hosomat. l lcd. ,
22 :
4 21, 1 96 0.
(b)
B R O W N ,
F.
,
C H A S E ,
J. am i(l WIN S TON J. S tu d ie s
in
in f ant f eed ing c hoices o f prim ip arae.
ii.
Coin-
p arison of R o rsc hac h determ inants o f acce pto rs
and re jectors o f b reast f eed ing .
J. P ro je ctive
Techniques,
25 : 412 , 19 61.
5. K A P L A N , H . I. aiid K A PL A N , H . S . T he psy cho so -
m atic co nce pt o f o bes ity . J. Ne rv. 1 ent. D is .,
1 2 5 : 1 8 1 , 1 9 5 7 .
6. H IL L , L . F. In f an t nu tri tiom i. .1 , ,:. J. (un. Na /ri-
tion, 3 : 75, 195 5.
7 . B UR CH IN A L,
L . G .
and E PPR IG H T , E . S . T est o f the
p sy c hog en ic theo ry of o bes ity in a sam ple o f rural
girls. Am. J. C/in. Nutrition, 7 : 2 8 8 , 1 9 5 9 .
F R E E D ,
S . C .
Psy ch ic f acto rs in
th e
d e v e l o p me n t
an d treatm e nt o f ob esity . J.A . 11f.A
1 3 3 : 3 6 9 ,
1947.
9. H AMBU RG E R W . W . Psy ch olo gic al aspe cts o f
obes i ty . Bull. New Yo rk Ac ad. lie d., 33 : 7 71 .
1 9 5 7 .
10 .
B R 0 sIN . J. T h e p sy ch o lo g y o f o v ereatin g . Ne w
England J. Med., 248 : 974 , 19 53.
1 1. S C H w A R T z . A .
S . E atin g p ro b lem s . P ediat. Cli;z.
No rth Ame rica ,
5 : 5 9 5 , 1 9 5 8 .
12 .
P A L E R M O
D . S . T lium nb suc k im ig-a learned re -
sponse. Pediatrics, 17: 392 , 1 956 .
1 3 . B R A Z E T T O N , T . B . S uc k in g in in f an cy .
Pediatrics,
1 7:4 00 , 19 56 .
1 4 . H 0N z IK , M . P. an d M C K E E ,
J. P.
T he se x dif f er-
ence
in
t h u mb s u c k i n g . J. P edia t.
.
61 : 7 26 , 19 62.
15 .
E A R N S H A W ,
J)#{149}. T he b aby s b irth righ t : a ple a
f o r a retu rn to e x terio r ges tation
and b reast f eed -
in g . .1 . J . . lu str al za , 4 8: 23 8, 19 61.
16 . J o N E s , W . 0 . O ii f ee d ing at
the b reasts. Pedi-
atrics, 28 : 851 , 196 1.
17 . DAVIS H . V ., S E A R S , R . R . , M I L L E R H . C . af l( l
B RO D B E CK P. J. E f f ects o f cu p , b ottle am id
b reast f ee din g o n oral activ ities of ne w b orn in-
fants . l ediatrics , 3 : 54 9, 194 8.
18 . S TUNKARD .\. J. Phy s ical ac tiv i ty , em otions aiid
h uim ian o be sity .
P svcho so ma t. Med. ,
20 : 36 6,
1958.
19 . I L L I N G S \ V 0 R T I I , it. S . O b esity . J. P edia tri cs , 53 :
11 7, 19 58.
20 . \ V O L F F , 0. H . O be sity in childhood.
Quart.
J.
Me d 2 4: 1 09 19 55 .
21 . BALDW IN B . T . T he Phy sical G ro w th of C hild ren
from B irth to M atu rity . Io w a C ity , 1 922 .
U niv ers ity o f Iow a Press .
22 . FABER H . K . A w eight rang e f o r c hildre n 5-15
years . Am. J. D is. Child., 3 8: 75 8, 1 92 9.
23 . S T U A R T , H . C . an d ME R E D I T H H . V . U se of body
m easure m e nts in the sch ool he alth pro grani.
Am. J. P ub. He alth, 36: 1 365 , 1 94 6.
24 .
BA I N K . T h e in c id en ce o f b reas t f e ed in g iii
hos -
p itals in the U nite d S tates. Pediatrics, 9 : 3 13,
1948.
25 MEY E R H . F. B reas t f eed ing in th e U nite d S tate s.
E x ten t an d p o ss ib le
tr end . Pediatrics, 22 : 11 6,
1 9 5 8 .
26 . J A CK SON E . B . , WI LK I N L . C . an d AUERBA dH H .
S tatistic al repo rt on inciden ce and du ration of
b reast f ee din g in relation to pe rso nal, soc ial am id
h osp ital m ate rnity f acto rs.
Pediatrics,
17 : 70 0,
1 9 5 6 .
27 . VANKAUER A ., B O E K , W . E . , LAWSON E . D . an d
I A N N I , F. A . J. S o c ial stratif ication and he alth
p rac tice s in c hild-b earing and child-rearing .
m
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f e eding itm
decline. Brit. M. J., 2 : 1 74 4 1 96 2.
31 . FA LK N ER ,
F. T h e
p hy sical d ev e lop m e nt o f ch ild -
ren . A g u id e to in terp retatio n of gro w th -ch arts
an d de v elopm en t o f assessm e nts ; an d a c om m e n-
tary on co nte m p orary and f u ture pro ble m s.
Pediatrics, 29 :44 8. 19 62.