Topic 5 - Cultural Impact on Infant Feeding Practices Flashcards
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.
lower incidence of infant diarrhea and respiratory disease.
_________ 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.
Exclusive breast milk- not even water
• 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
six months, gradual introduction of solids
colostrum
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
BF initiation has risen over the number of years
Canada and USA
–Lower SE brackets have _____ initiation and duration rates
–EXCEPT in ____ _________ – their rates of initiation and duration are higher
–___________ = declining rates
Lower SE brackets = lower initiation, lower duration rates
EXCEPT in new immigrants
acculturation = lower rates
- 37% EBF to 4 months
- 17% EBF to 6 months
(exclusive breast feeding)
- Alberta 22% EBF to at least 6 months
* BC 28% EBF to at least 6 months
Breastfeeding. It’s your right!
• Your right to breastfeed anywhere, anytime is protected by the Canadian Charter of Rights and Freedoms.
• Each province and territory has a Human Rights Code protecting women from discrimination on the basis of sex.
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.
provided with accommodation
- Allowing for the extension of maternity leave.
- Allowing for alternative work arrangements.
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)
– Family/work/educational demands
– Cultural beliefs and traditions
– Personal beliefs
– support (real or perceived)
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”
Religion as a Motivation
b. Culture
- ________ influence: Prelacteal feedings
- No role models within?
Often negative influence
c. Society
- Potential negative attitudes toward breastfeeding?
- Unsupportive, discouraging Western society
Societal norms
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)
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)
No cultural support for traditional maternal postnatal practice
Beliefs about maternal and breastfeeding health not supported
leads to an increase in ______ _______
Increase in formula feeding
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
traditional post natal healing foods mothers
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.
- 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.
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
• no role models
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)
infant undernutrition
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.
regarding colostrum
delayed breastfeeding and decreased stimulation of milk production.
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).
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.
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)
softened date
sugar and salt
– Clean the stomach (herbal paste)
– Sooth infant until true milk arrives
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
Brown sugar + ghee, to write OM on tongue
– Benefits to infant’s gastrointestinal and urinary systems, evacuate meconium
• ______ 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?
Honey
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 ______.
milk as food
supplemented with water
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.
Thai babies - rice porridge
British and Carribean babies get “gripe water”
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
thicker and yellower
high in nutrients, immunoglobulins and leukocytes
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.
looks different
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.
China - colostrum seen as dirty
Philippines - ‘dirty milk’
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.
prelactal feeding
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
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)
Implications and Barriers
- Negative impact on exclusive breastfeeding but great duration.
- Negative reaction from western society at length of duration.
• Barriers are similar to non-middle eastern mothers:
– Work/school
– Concerns about public BF
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
emic perspective
first year
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
lack of guidelines
pre-lactal feeds
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.
other than milk or formula
risk of overfeeding or allergies
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
not until 6 months
variable across cultures
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.
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.
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)
practiced by pre- industrial societies
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.
9 months
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.
atopic diseases including asthma
saliva contains antibodies (to viruses) and bacterial antigens
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.
food allergens
reducing allergic responses to foods
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.”
be sensitive, nonjudgmental in their approach
