The Baby-friendly Hospital Initiative (BFHI) is a key component of the World Health Organization/United Nations Children's Fund Global Strategy for Infant and Young Child Feeding. The primary aim of this narrative systematic review was to examine the impact of BFHI implementation on breastfeeding and child health outcomes worldwide and in the United States. Experimental, quasi-experimental and observational studies were considered eligible for this review if they assessed breastfeeding outcomes and/or infant health outcomes for healthy, term infants born in a hospital or birthing center with full or partial implementation of BFHI steps. Of the 58 reports included in the systematic review, nine of them were published based on three randomized controlled trials, 19 followed quasiexperimental designs, 11 were prospective and 19 were cross-sectional or retrospective. Studies were conducted in 19 different countries located in South America, North America, Western Europe, Eastern Europe, South Asia, Eurasia and Sub-Saharan Africa. Adherence to the BFHI Ten Steps has a positive impact on short-term, mediumterm and long-term breastfeeding (BF) outcomes. There is a dose-response relationship between the number of BFHI steps women are exposed to and the likelihood of improved BF outcomes (early BF initiation, exclusive breastfeeding (EBF) at hospital discharge, any BF and EBF duration). Community support (step 10) appears to be essential for sustaining breastfeeding impacts of BFHI in the longer term.
Responsive parenting is a caregiving style expected to foster the development of self-regulation and promote optimal cognitive, social, and emotional development from the beginning of life. Critical dimensions of responsive parenting include feeding, sleeping, soothing, and play/physical activity; all are highly interconnected with each other. Responsive parenting interventions have been shown to have a beneficial impact on child feeding behaviors and weight outcomes. An expert panel convened by Healthy Eating Research, a national program of the Robert Wood Johnson Foundation, developed evidence-based guidelines for feeding infants and toddlers during the first 2 years of life. These responsive feeding guidelines were developed after an evidence-based consensus methodology. The guidelines address the periods of gestation, birth to 6 months, more than 6 months to 1 year, and more than 1 to 2 years. Fundamental principles of the guidelines include hunger and satiety cues, developmental milestones that indicate readiness for introduction of solids, and responsive approaches to repeatedly expose the young child to a variety of healthy foods and age-appropriate textures in the context of a stable and predictable nurturing environment.
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