university of tennessee, knoxville 3/26/10 promong healthy...

University of Tennessee, Knoxville Promo4ng Healthy Weight Colloquium

3/26/10

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Ka4e Kavanagh, PhD, RD The University of Tennessee, Department of Nutri4on

Program in Public Health Nutri4on

Promo4ng Healthy Weight Colloquium March 26, 2010

DO FATHERS MATTER IN THE INFANT-FEEDING DECISION?

CURRENT EVIDENCE AND FUTURE DIRECTIONS

OVERVIEW

  Background

  Infant‐feeding decisions

  Role of father

  The changing rela4onship

  Can fathers make a difference?

  Summary/Conclusions

BACKGROUND


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BENEFITS OF BREASTFEEDING FOR INFANTS

 Op4mal nutri4on

  Enhanced immunity

  Reduced risk for O44s media, Nonspecific gastroenteri4s, Severe lower respiratory tract infec4ons, asthma

  Reduced risk for, Obesity, type 1 and 2 diabetes, heart disease, Hypertension, Hypercholesteralemia, childhood leukemia

  Reduced risk for SIDS

  Bonding

  Protec4on against allergies and intolerances

  Promo4on of proper jaw and teeth development

  Safe (no prep)

James DCS, Lessen R. Posi4on of the American Diete4c Associa4on: Promo4ng and Suppor4ng

Breas^eeding. JADA 2009;109:1926‐1942.

BENEFITS OF BREASTFEEDING FOR MOTHERS

  Strong bonding with infant

  Increased energy expenditure

 More rapid return of uterus to prepregnancy status

  Reduced PPT bleeding and delay in return of menstrual cycle

 Decreased risk of type 2 diabetes

 Decreased risk of breast and ovarian cancer

  Improved bone density, decreased risk for hip fracture

 Decreased risk of PPT Depression

  Enhances self‐esteem in maternal role

  Convenient (no formula to prep)

  Free – aside from minimal cost of addi4onal calories



BENEFITS TO SOCIETY

  USDA es4mates: > $3.6 billion could be saved in health care costs if current gaps between behavior and recommenda4ons closed

  Es4mate only includes o44s media, gastroenteri4s, and necro4zing enterocoli4s

  Does not account for

  Reduced absenteeism

  Reduced risk for chronic diseases later in life




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INFANT FEEDING RECOMMENDATIONS

  The American Academy of Pediatrics recommends “exclusive breasêeding for approximately the first six months and support for breasêeding for the first year and beyond as long as mutually desired by mother and child”

  In addi4on, the 2010 Healthy People target is have at least

  75% of mothers ini4ate breasêeding

  40% exclusively breasêeding at 3 months

  50% breasêeding at 6 months (17% exclusively)

  25% breasêeding at 1 year

Gartner LM, Morton J, Lawrence RA, et al. Breasêeding and the use of human milk. Pediatrics 2005;115(2):496‐506. USDHHS. Healthy People 2010, Volume II. Washington, D.C. Available at: hmp://www.healthypeople.gov/DOCUMENT/HTML/Volume1/toc.htm Accessed March 24, 2010.

HOW ARE WE DOING AS A NATION?

Most current na,onal rates*

Healthy People 2010 Objec,ves

Ever breasêd 73.9% 75%

Exclusively breasêd (through 3 months)

33.1% 60%

Breasêd at 6 months 43.4% 50%

Exclusively breasêd (through 6 months)

13.6% 25%

Breasêd at 12 months 22.7% 25%

* Varies significantly by state Kogan MD, Singh GK, Dee DL, et al. Mul4variate analysis of state varia4on in breasêeding rates in the United States. AJPH 2008;98(10):1872‐1880. Centers for Disease Control and Preven4on, USDHHS. Breasêeding Report Card. Na4onal Immuniza4on Survey. Available at: hmp://www.cdc.gov/BREASTFEEDING/DATA/report_card.htm Accessed March 24, 2010. USDHHS. Healthy People 2010, Volume II. Washington, D.C. Available at: hmp://www.healthypeople.gov/DOCUMENT/HTML/Volume1/toc.htm Accessed March 24, 2010.

COMMON BARRIERS FOR BREASTFEEDING

  Ini>a>on

  Lack of knowledge, unsuppor4ve hospital prac4ces, personal beliefs, family artudes

  Dura>on/Exclusivity

  Percep4on of insufficient milk, concern infant is not gerng “enough”, nipple or breast problems, maternal fa4gue, maternal return to work, embarrassed to breasêed in public, and being the only one who can feed the infant




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INFANT-FEEDING DECISIONS

WHAT DECISIONS ARE MADE?

  Breast or formula?

  Breast and formula?

  Formula only?

  Formula and infant cereal?

  Formula, cereal, solid foods?

These are of primary concern when introduced prior to 4 months of age

WHAT INFLUENCES MOTHERS TO CHOOSE INFANT-FEEDING MODE?

  Breasêeding ini4a4on

  Hospital prac4ces

  Maternal artude, knowledge and self‐efficacy

  Oten decisions are made before pregnant

  Breasêeding dura4on/exclusivity

  Maternal artude, knowledge and self‐efficacy

  Access to breasêeding support

  Support of their families (we will focus on fathers)

James DCS, Lessen R. Posi4on of the American Diete4c Associa4on: Promo4ng and Suppor4ng Breasêeding. JADA 2009;109:1926‐1942.


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ROLE OF FATHER

HOW DO FATHERS INFLUENCE BREASTFEEDING

DECISIONS?   A bit of conflic4ng evidence

  In a review, Sharma & Petosa found that fathers play an important role in the breast‐feeding decision

  A majority of mothers are directly influenced by the father's beliefs and concerns about breast‐feeding

  Fathers have some knowledge, but have both posi4ve and nega4ve beliefs about breasêeding

  However, Heinig et al found that fathers are not always considered important in decision making and mothers do not always value their advice

  Understanding these beliefs, and the establishment of the family rela4onship, is cri4cal to successfully intervening to increase breasêeding ini4a4on, dura4on and exclusivity

Sharma M, Petosa R. Impact of expectant fathers in breast‐feeding decisions. JADA 1997;97:1311‐1313. Heinig MJ, Ishii KD, Banuelos JL, et al. Sources and Acceptance of Infant‐Feeding Advice Among Low‐Income Women. JHL 2009;25:163‐172.


DECISIONS?   Father knowledge included

  Protec4on against disease

  Increase in bonding

  Is the more natural method

  Posi4ve artudes included

  That breasêeding is bemer for the baby

  A general respect for women who do breasêd

  That it is the healthier choice for the baby

Sharma M, Petosa R. Impact of expectant fathers in breast‐feeding decisions. JADA 1997;97:1311‐1313.


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DECISIONS?  Nega4ve artudes included

  That it was less amrac4ve [than formula‐feeding]

  That it was bad for breasts

  That it makes breasts ugly

  The perceived lack of opportunity to develop a rela4onship with the child

  Feelings of inadequacy

  Separa4on from the mate

  Feeling of being let out

  Interference with sex

  Envious of special bond

 Dislike for breas^eeding in public

  Ar4ficial feeding is easier

  Children grow bemer with ar4ficial feeding

Sharma M, Petosa R. Impact of expectant fathers in breast‐feeding decisions. JADA 1997;97:1311‐1313.

THE CHANGING RELATIONSHIP

THE CHANGING RELATIONSHIP: THE FIRST 4 MONTHS

  Birth event

  Breas^eeding

 New rela4onship

  Infant care

  Support

Goodman JH. Becoming an involved father of an infant. Jognn‐Journal of Obstetric Gynecologic and Neonatal Nursing 2005;34:190‐200. Bell L, Goulet C, Tribble DSC, Paul D, Boisclair A, Tronick EZ. Mothers' and fathers' views of the interdependence of their rela4onships with their infant ‐ A systems perspec4ve on early family rela4onships. J Fam Nur 2007;13:179‐200.

Concerns include

  Recogni4on of effort

  Time/interac4on with infant

 Work

 How he is viewed within his sociocultural context


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 Father enters fatherhood with expecta4ons and concerns and must manage his changing role

 Understanding new role

 Developing new strategies to func4on

  Learning about his infant

  Accep4ng changes in rela4onship with mother

Goodman JH. Becoming an involved father of an infant. Jognn‐Journal of Obstetric Gynecologic and Neonatal Nursing 2005;34:190‐200. Bell L, Goulet C, Tribble DSC, Paul D, Boisclair A, Tronick EZ. Mothers' and fathers' views of the interdependence of their rela4onships with their infant ‐ A systems perspec4ve on early family rela4onships. J Fam Nur 2007;13:179‐200.


  The father may feel the need to maintain role as provider

  Must focus on economic stability

  Must provide physical and emo4onal support to mother outside of work hours

  However, wants to be included in educa4on as much as mother

  Is aware of the need to support the mother and expresses the desire for her to guide him in this support

Halle C, Dowd T, Fowler C, et al. Suppor4ng fathers in the transi4on to parenthood. Contemp Nur 2008;31:57‐70. Anderson K, Nicklas JC, Spence M, Kavanagh K. Roles, Percep4ons, and Control of Infant Feeding among Low‐Income Fathers. PHN 2010;13:522‐530.


  Fathers’ voices

  ‘stay calm, never lose your cool and be pa>ent’

  ‘even if the day might be going smoothly, don’t be thinking there’s now >me for something extra because the rest that you’ve been experiencing will be needed soon to cope with an unseNled period long overdue’

  ‘When it gets too much – swap with your partner. Always be suppor>ve of your wife’s situa>on’

Halle C, Dowd T, Fowler C, et al. Suppor4ng fathers in the transi4on to parenthood. Contemp Nur 2008;31:57‐70.


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 By 4 months of age a new rela4onship is created

Bell L, Goulet C, Tribble DSC, Paul D, Boisclair A, Tronick EZ. Mothers' and fathers' views of the interdependence of their rela4onships with their infant ‐ A systems perspec4ve on early family rela4onships. J Fam Nur 2007;13:179‐200. © Kavanagh, 2010.


  Superimpose recommenda4ons of breas^eeding dura4on and exclusivity over this first 4 months

  Father clearly fits into the educa4onal strategies of healthcare providers

© Kavanagh, 2010.

SO, CAN FATHERS MAKE A DIFFERENCE?


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SO, CAN FATHERS MAKE A DIFFERENCE?

  Stremler J, Lovera D. Insight from a breasêeding peer support pilot program for husbands and fathers of Texas WIC par4cipants. Journal of Human Lacta4on 2004;20:417‐422.

  In this pilot work, fathers as peer‐counselors appeared to increase breasêeding ini4a4on among WIC par4cipants but…

  No comparison group

  Only evaluated ini>a>on

  However, feedback from fathers was overwhelmingly posi4ve and this program may have more to report later

  Next: Wol}erg AJ, Michels KB, Shields W, O'Campo P, Bronner Y, Bienstock J. Dads as breasêeding advocates: Results from a randomized controlled trial of an educa4onal interven4on. American Journal of Obstetrics and Gynecology 2004;191:708‐712.

DADS AS BREASTFEEDING ADVOCATES: RESULTS FROM A RANDOMIZED CONTROLLED TR IAL OF AN

EDUCATIONAL INTERVENTION

  Objec4ve: tes4ng simple, prenatal, educa4onal interven4on encouraging fathers to encourage their partners to breasêed

  Study design: RCT

  Interven4on group: 2‐hour class on infant care and breasêeding promo4on

  Control group: 2‐hour class on infant care only

  Subjects: Partners of women seeking prenatal care at Johns Hopkins Hospital



  Interven4on

  Informal environment

 Non‐didac4c

 Mul4ple media

  Video

  Slides

  Role‐playing

  Focused on suppor4ng their partner in choosing breasêeding

  Control

  Same approach, but did not address breasêeding


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  Outcome measures

  Breasêeding ini4a4on

  Breasêeding dura4on at 4, 6, and 8 weeks PPT

  Sta4s4cal analyses

  Outcome measures coded dichotomously at each 4me point

  Chi‐squared at each 4me point

  Logis4c regression using adjusted chi‐squared values



  Results

  567 mothers were screened

  Only 59 fathers amended class

  Only 57 mothers completed study ac4vi4es

  These par4cipants were different from those who did not par4cipate

  Less likely to receive government assistance

  More likely to be employed



  Results

  No differences, demographically, between groups

  Mothers were significantly more likely to ini4ate breasêeding (p=0.02) if fathers had amended interven4on group

  20/27 (74%) in interven4on group vs. 13/32 (41%) in control


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  Results

  Maternal breasêeding inten4on, maternal grandmother’s belief that breasêeding should occur, and the infant’s fathers belief that breasêeding should occur were all significantly associated with a mother ini4a4ng breasêeding, even ater adjus4ng for group assignment

  In addi4on, having the father amend the interven4on class appeared to have an addi4ve effect if mother had expressed inten4on to breasêed

  However, by 4 weeks of age, both groups were breasêeding at the same rate



  Limita4ons

  May have included selec4on bias (amri4on)

  Conclusions

  Fathers may play a role in encouraging mothers to breasêed, via increased knowledge of the benefits of breasêeding

  Authors did not address, but dura4on was unaffected

  Future work suppor4ng dura4on and exclusivity needed

SUMMARY/CONCLUSIONS


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FATHERS DO MATTER!

  Fathers can and do influence the mother’s choice to ini4ate breas^eeding, but this depends on whether or not his opinion is valued

  Father‐directed educa4on may increase the value of their opinion

  Fathers WANT informa4on, support, and recogni4on

  Fathers can be effec4ve advocates, and “protect” the mother/infant dyad in the early weeks

FATHERS DO MATTER!

  Fathers find sa4sfac4on in helping the mother in what ever way is needed

  And mothers need to express how fathers can best support them

  Fathers influence ini4a4on, but it is unknown how they may influence dura4on and exclusivity, and introduc4on of other foods later in the first year of life

  Fathers need to be included in educa4on, both pre‐ and post‐natally

  Poten4al is there for male‐peer‐counselors to be an effec4ve mechanism

FATHERS DO MATTER!

© Kavanagh, 2010

university of tennessee, knoxville 3/26/10 promong healthy...

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