Topic 5 - Cultural Impact on Infant Feeding Practices

Question 1

Why is breastfeeding important?

• Breastfeeding is associated with a lower incidence of infant __________ and __________ disease, particularly in less developed countries.
• It has the optimal nutrients for growth and development.

Answer 1

lower incidence of infant diarrhea and respiratory disease.

Question 2

_________ breast milk – no food or liquid other than breast milk, not even _____, is given to the infant from birth by the mother, health care provider, or family member/supporter.

Answer 2

Exclusive breast milk- not even water

Question 3

• World Health Organization: all infants should be exclusively breastfed from birth to ____ months of age followed by continued breastfeeding and the ______ ___________ of solids.

• Breastfeeding should be initiatedsoon after birth to ensure:
–baby receives the first milk called ________ –success of breastfeeding

Answer 3

six months, gradual introduction of solids

colostrum

Question 4

Canada - Percentage of mothers who initiated breastfeeding, 1965 to 2003

1965 – 25% initiate BF
1980s - 62% initiate BF
1990s - 75% initiate BF 2003 – 85% initiate BF

Answer 4

BF initiation has risen over the number of years

Question 5

Canada and USA

–Lower SE brackets have _____ initiation and duration rates

–EXCEPT in ____ _________ – their rates of initiation and duration are higher

–___________ = declining rates

Answer 5

Lower SE brackets = lower initiation, lower duration rates

EXCEPT in new immigrants

acculturation = lower rates

Question 6

• 37% EBF to 4 months
• 17% EBF to 6 months

(exclusive breast feeding)

Answer 6

• Alberta 22% EBF to at least 6 months

* BC 28% EBF to at least 6 months

Question 7

Breastfeeding. It’s your right!

• Your right to breastfeed anywhere, anytime is protected by the Canadian Charter of Rights and Freedoms.

Answer 7

• Each province and territory has a Human Rights Code protecting women from discrimination on the basis of sex.

Question 8

Breastfeeding is a human right in Canada

• Employees who breastfeed or express/pump breast milk should be provided with ______________.
• Providing a suitable clean place to breast- feed or express milk and to store milk.
• Providing longer or extra breaks for the purpose of breast-feeding or expressing milk.

Answer 8

provided with accommodation

• Allowing for the extension of maternity leave.
• Allowing for alternative work arrangements.

Question 9

Factors Effecting Infant Feeding Decisions
What and how women base their infant feeding decisions on is based on factors other than (in addition to?) clinical guidelines and science:

– Family/work/educational demands
– ________ beliefs and traditions
– Personal beliefs
– Level of _______ (real or perceived)

Answer 9

– Family/work/educational demands
– Cultural beliefs and traditions
– Personal beliefs
– support (real or perceived)

Question 10

Examples: Cultural/ Societal Influences
a. Religion as a __________

“…Mothers should give suck to their children for two whole years, for those parents who desire to complete the term.”
(Verse 2:233, Q’uran)

• Inability to adhere: 40 days post-delivery rest, adopting a “wet nurse”

Answer 10

Religion as a Motivation

Question 11

b. Culture

• ________ influence: Prelacteal feedings
• No role models within?

Answer 11

Often negative influence

Question 12

c. Society

• Potential negative attitudes toward breastfeeding?
• Unsupportive, discouraging Western society

Answer 12

Societal norms

Question 13

Macrosystem (Culture/society/religeon)

Exosystem (Norms of community, workplace, public)

Mesosystem (Health care systems, policy and professionals)

Microsystem (Family, friends, social networks, peers)

Mother-infant dyad (Problems, knowledge, attitudes, beliefs)

Answer 13

Macrosystem (Culture/society/religeon)
Exosystem (Norms of community, workplace, public)
Mesosystem (Health care systems, policy and professionals)
Microsystem (Family, friends, social networks, peers)
Mother-infant dyad (Problems, knowledge, attitudes, beliefs)

Question 14

No cultural support for traditional maternal postnatal practice

Beliefs about maternal and breastfeeding health not supported

leads to an increase in ______ _______

Answer 14

Increase in formula feeding

Question 15

Example – Hot/cold feeding tradition

• Without family support and supply of __________ _____ ______ healing foods mothers will be concerned for their own health

• Breastfeeding uses up hot energy
• Milk will be unhealthy for baby

Answer 15

traditional post natal healing foods mothers

Question 16

Breastfeeding and taste acceptance

• Mother’s milk reflects the food culture into which a baby is born.
• The taste and aroma of breast milk is influenced by the taste and aroma of food consumed by the mother.
• Taste experience is a factor in developing the food habits of a culture.

Answer 16

• Mother’s milk reflects the food culture into which a baby is born.
• The taste and aroma of breast milk is influenced by the taste and aroma of food consumed by the mother.
• Taste experience is a factor in developing the food habits of a culture.

Question 17

Western examples of culturally differences in infant feeding

Low income African American (USA)
• no ____ models
• creation of ‘needy’ children

Canadian regional/cultural differences
– BC BF rates vs Maritimes – Aboriginal
– Teenage mothers

Answer 17

• no role models

Question 18

Consider the cultural differences about weight and health…..

• Over feeding with formula could be a result of fears of infant _______________.
• Consider the cultural significance of weight with health (i.e.;plump baby is a healthy baby)

Answer 18

infant undernutrition

Question 19

Prelacteal Feeding

• Taboos regarding __________.
– ‘cleansing foods’
– Inappropriate for newborn?

• Teas, sugar water, herbs honey…substituted
• Early hospital discharge impacts cultural feeding opportunities
• Biggest concern?–delayed _____________ and decreased stimulation of milk production.

Answer 19

regarding colostrum

delayed breastfeeding and decreased stimulation of milk production.

Question 20

Prelacteal feeds

• In many cultures, prelacteal feeds are given to the infant before initiating breastfeeding for the first time because of the belief that they act as laxatives, _________ agents, or __________ agents, or as a means of eliminating the _________ (first stool).

Answer 20

prelacteal feeds - cleansing/rehydrating agents or eliminating the meconium

– i.e.; Asian Indian scriptures recommend feeding honey to the neonate with the objective of expelling meconium

• PLF results in the baby receiving insufficient breast milk and colostrum and may lead to lactation failure and diarrhea.

Question 21

Examples of perceived benefits Muslim:

– Softened ____ – provides ‘sweet’ as the infant’s first taste (practice is called tahneek)

– ______ and ____ help to increase the infant’s urination which releases their heat and makes them hungry (necessary to grow)

Answer 21

softened date

sugar and salt

– Clean the stomach (herbal paste)
– Sooth infant until true milk arrives

Question 22

Examples of perceived benefits Hindu:

– Brown sugar (jaggery) dipped in ghee is used to write ‘OM’ on infant’s tongue

– Evacuate _________, reduce colic, laxative

– Discarding colostrum ‘cleanses’ mother’s mammary glands
• Similar ceremony to Muslims
• Deeply rooted in Hindu culture

Answer 22

Brown sugar + ghee, to write OM on tongue

– Benefits to infant’s gastrointestinal and urinary systems, evacuate meconium

Question 23

• ______ is often used as a prelacteal feeding

• Some concerns with infant botulism –
Underdeveloped immunological system – Rare, but serious

• Health Canada currently recommends not giving honey to infants under the age of one
• A health education opportunity?

Answer 23

Honey

Question 24

Cultural beliefs about breast milk

• Chinese see breast milk as ____.
• 吃奶 means “eat milk”
• This idea along with some Chinese medicine has lead to the belief that all babies, even right after birth, need to be supplemented with ______.

Answer 24

milk as food

supplemented with water

Question 25

Other reasons for prelacteal feeds

• Rural ____ babies are given ____ ________ to protect them from roving “spirit parents”
• British and _________ babies get “_____ water” as a therapy for gas
• African-American babies get cereal to help them sleep at night.
• Babies everywhere are given water (unnecessarily) when people think they may be thirsty or when their mothers are busy elsewhere.

Answer 25

Thai babies - rice porridge

British and Carribean babies get “gripe water”

Question 26

Colostrum

• The first milk present in the first few days.
• ______er and ______er than latermilk.
• It’s composition is different from later
milk.
– It is highly concentrated in ________.
– It is high in immuno________ and ______cytes, which have the ability to destroy bacteria and viruses

Answer 26

thicker and yellower

high in nutrients, immunoglobulins and leukocytes

Question 27

Colostrum and Culture

• Mothers in many cultures withhold colostrum from the newborn.
• Because colostrum may not be abundant and ______ ________ than mature breastmilk (and very different from formula) women may doubt it’s ability to nourish a newborn.

Answer 27

looks different

Question 28

Reasons for Delaying the Feeding of Colostrum

• In ______, “colostrum” is considered stale or dirty, therefore it is discarded.
• In the ___________ colostrum is thought of as ‘dirty milk’
• Asian Indian mothers in the United States and India may believe that colostrum causes indigestion.

Answer 28

China - colostrum seen as dirty

Philippines - ‘dirty milk’

Question 29

Implications/Application

Health professionals are encouraged to understand the maternal reasons for withholding colostrum and ___________ ______and to give compatible messages about breastfeeding to all women of all cultural groups.

Answer 29

prelactal feeding

Question 30

Middles Eastern immigrants:

– Fast growing population in ______
– Breastfeeding rates appear unaffected by _________ to the same degree as other immigrate populations

– Greatest BF rates compared to host countries

Answer 30

Fastest growing in Alberta
unaffected by acculturation compared to other immigrant populations

– Religious dedication to breastfeeding (verse in Q’uran)
– Have strong tradition of prelacteal feeding

Mashed dates (Halawi)

Rice pudding (Muhallabia/Firni)

Question 31

Implications and Barriers

• Negative impact on exclusive breastfeeding but great duration.
• Negative reaction from western society at length of duration.

Answer 31

• Barriers are similar to non-middle eastern mothers:
– Work/school
– Concerns about public BF

Question 32

Objectives of the study

• No previous study evaluated the cultural beliefs of new- settler Arab and Persian mothers with regards to infant feeding from an _____ perspective
– Ensure cultural competency
– language was not a barrier
– Comfort level of study participants

• To assess the perceptions, experiences, attitude, beliefs and cultural norms that shape infant feeding practices of Middle Eastern women residing in Canada
• To evaluate Middle Eastern infants’ food and drink intakes during the ____ ____of life

Answer 32

emic perspective

first year

Question 33

Heath Practitioner implications.

• Lack of relevance and practicality of infant feeding ________ as the main reasons for ignoring infant feeding recommendations.
• Early introduction of ___-_____ feeds and inappropriate types of foods jeopardize BF exclusivity.

– Cause of concern? Should it be?) • Exclusivity VS duration….
• Cultural competency is a MUST

Answer 33

lack of guidelines

pre-lactal feeds

Question 34

Beikost

• The German word beikost translates as “foods other than ____ or _______.”

– first strained foods that are given to a young infant as a supplement to breast milk or formula.

• First foods introduced vary by country, but are generally
• If solid foods are added too soon, there is a risk of ________ or outcomes such as food _______, diarrhea, or malnutrition.
• If solid foods are of poor quality, the baby will become malnourished.

Answer 34

other than milk or formula

risk of overfeeding or allergies

Question 35

First Foods

• CPS recommends that complimentary foods to breast milk are not introduced until _ months of age
• However, we know that the introduction of complimentary food practices are ______ across cultures

Answer 35

not until 6 months

variable across cultures

Question 36

When to feed solids?

• Infants experience before they are physically capable of consuming ___ ____from external sources.

– ___ ____ – rich in iron, zinc and protein – is difficult to feed to young infants without some form of processing or puréeing.

Answer 36

heme iron from external sources

Red Meat is difficult to feed

• Baby teeth develop late, especially molars, which only erupt at about 18–24 months.

Question 37

Pre-chewed food for infants

• Practiced by almost all ___-_______ societies.

• Presently discouraged in many countries.
– ‘Yuck’ factor; considered unhygienic
• 14% of US mothers may chew their infants’ food ( premastication)

Answer 37

practiced by pre- industrial societies

Question 38

Digestive enzymes in saliva

At birth, there is a physiologic deficiency of pancreatic amylase. It is not until _ months of age that adult values are reached.

Answer 38

9 months

Question 39

Early exposure to pathogens

• Modern sanitary environments markedly increases the risk of _____ diseases
– localized hypersensitivity reaction to an allergen

• Early exposure to a rich microbial environment is important in priming the immune system.
• The presence of pathogens in saliva does not necessarily mean that they are infectious, especially because saliva contains IgG, IgM and especially secretory IgA, which contain anti______to viruses and bacterial anti, and inhibit bacterial attachment to host tissues, thus controlling bacterial, fungal and viral colonization.

Answer 39

atopic diseases including asthma

saliva contains antibodies (to viruses) and bacterial antigens

Question 40

Early exposure to allergens

• Early exposure to potential food ______ in premasticated foods, particularly when the infant is still breastfeeding, may also have a role in _____ _______ responses to foods.

Answer 40

food allergens

reducing allergic responses to foods

Question 41

What to do when caregivers pre-chew?

“Medical providers should be sensitive to these cultural practices and remain nonjudgmental in their approach to families who use them in the absence of any documentation of ill effects. Acknowledging these practices to parents or other care givers can help forge a stronger relationship with the families who have different child care practices than the health provider.”

Answer 41

be sensitive, nonjudgmental in their approach