Effectiveness of a social support intervention on infant feeding practices: randomised controlled trial

Abstract

Background: To assess whether monthly home visits from trained volunteers could improve infant feeding practices at age 12 months, a randomised controlled trial was carried out in two disadvantaged inner city London boroughs. Methods: Women attending baby clinics with their infants (312) were randomised to receive monthly home visits from trained volunteers over a 9-month period (intervention group) or standard professional care only (control group). The primary outcome was vitamin C intakes from fruit. Secondary outcomes included selected macro and micro-nutrients, infant feeding habits, supine length and weight. Data were collected at baseline when infants were aged approximately 10 weeks, and subsequently when the child was 12 and 18 months old. Results: Two-hundred and twelve women (68%) completed the trial. At both follow-up points no significant differences were found between the groups for vitamin C intakes from fruit or other nutrients. At first follow-up, however, infants in the intervention group were significantly less likely to be given goats' or soya milks, and were more likely to have three solid meals per day. At the second follow-up, intervention group children were significantly less likely to be still using a bottle. At both follow-up points, intervention group children also consumed significantly more specific fruit and vegetables. Conclusions: Home visits from trained volunteers had no significant effect on nutrient intakes but did promote some other recommended infant feeding practices. Trial registration: Current Controlled Trials ISRCTN55500035Nutrition in early life is a key determinant of growth, development and health status, both in childhood and later adult life. Current UK recommendations advise all mothers to exclusively breastfeed for 6 months, and to delay introducing solids until at least 6 months. [3][4][5] Data from national surveys show that infant feeding practices in the UK are, however, highly variable.6 7 The 2005 Infant Feeding Survey indicated some encouraging trends with 76% of mothers across the UK initiating breastfeeding. However, rates fell steeply after a few weeks and less than 1% of mothers were exclusively breastfeeding at 6 months.6 Stark social inequalities were evident, with breastfeeding rates highest amongst older, middle-class and educated mothers. The 2005 survey also reported that 51% of mothers had introduced solids by 4 months and only 2% had delayed introducing solids until 6 months. Mothers giving solids when babies were 4-6 months were more likely to provide commercially prepared foods (85%) than home prepared (51%), and only 46% had given fruit. 6A substantial body of research has evaluated interventions aimed at increasing the initiation, and to lesser extent, the duration of breastfeeding.8 9 In contrast, very few well-designed studies have evaluated interventions focusing on the later stages of infant feeding beyond breastfeeding. 10Recent National Institute of Health and Clinical Excellence (NICE) guidance has highlighted the paucity o...

Systematic review of peer support for breastfeeding continuation: metaregression analysis of the effect of setting, intensity, and timing

“…5 However, none of the four UK based randomised controlled trials and the one quasi-randomised trial were able to show significant improvements in any or exclusive breastfeeding rates. [6][7][8][9][10] We hypothesised that differences in effects between studies may result from different levels of routine support for breast feeding in different settings or the intensity or timing of the delivery of the peer support intervention. It is probable that in settings where the routine level of support for breastfeeding mothers is high, more intensive interventions would be required to achieve an effect.…”

A novel peer-support intervention using motivational interviewing for breastfeeding maintenance: a UK feasibility study

“…33 This review found these interventions to be effective in increasing breastfeeding maintenance in low-or middle-income countries, reducing the risk of not exclusively breastfeeding by up to 28%. However, the UK-based RCTs of BFPS interventions included in this review did not find increases in breastfeeding continuation rates, [34][35][36][37] with no increase in breastfeeding maintenance at 8-10 weeks 35,37 and 4 months.…”

“…Four UK RCTs, [34][35][36][37] both individual and cluster randomised trials, had already demonstrated that it was feasible and acceptable to randomise pregnant women in the antenatal period to receive either BFPS or usual care. Two RCTs that randomised individuals recruited 70% 35 and 82% 34 of their intended sample size and cited difficulties in recruitment resulting from resource constraints.…”

“…The previous UK RCTs of BFPS [34][35][36][37] also highlighted the uptake of, and adherence to, the intervention as possible reasons for non-effectiveness. We therefore included a process evaluation in the design of this feasibility study, to include an assessment of the extent to which the MI-based BFPS intervention that we developed can be delivered as intended to the target population.…”

“…38 More recently, a time series analysis of a UK-based BFPS intervention delivered to a geographically defined population of adolescents found that, after adjusting for underlying trends, by the end of the study period, an additional 6.6 women in every 100 were initiating breastfeeding. 39 The UK-based interventions that have been studied were delivered as low-intensity interventions 34,37,38 and several did not include an intended first contact with the mother in the days after the birth; [34][35][36] in one UK-based study mothers were not contacted until their babies were around 3 months old. 36 In a UK context, this lack of early contact means that the intervention misses an important window, as breastfeeding discontinuation in the UK is highest during the early days and weeks after birth.…”