Maternal control of milk feeding: the role of attitudes, intentions and experiences

在英国，儿童肥胖水平正在上升，使儿童面临当前和未来健康问题的风险，对NHS资源产生重大影响。社会经济背景较低的儿童面临的风险更高。儿童营养是超重的一个主要危险因素，因此需要采取早期干预措施以减少肥胖风险。那些能意识到自己吃饱了而不吃得过饱的人更有可能拥有健康的体重。这种能力的差异可以从儿童时期就被识别出来。影响这种能力的一个因素是母亲对孩子饮食的控制程度。孩子天生就有调节食物摄入的能力，但限制摄入或强迫孩子摄入更多食物的行为可能会导致饮食习惯和超重问题。母乳喂养的母亲对孩子日后的饮食控制程度较低。有人假设（但未经检验）母乳喂养和配方奶粉喂养婴儿的喂养方式的差异可能解释了这一点。母乳喂养比配方奶喂养更“以婴儿为主导”。消耗的牛奶量不容易测量，喂养频繁和不规律以刺激牛奶供应。相反，配方奶喂养更明显，而且通常是按时间表进行的。这样就更容易追踪牛奶的摄入量。虽然母乳喂养的母亲需要遵循婴儿的提示来喂养，但配方奶喂养的母亲有更大的控制力和机会来操纵摄入量。这些差异可能会影响到后来的喂养方式。另外，希望对喂养有高度控制的母亲通常会选择配方饲料，因为有更大的机会操纵喂养，并继续对以后的饮食施加更高水平的控制。我的博士研究探索了这种关系，研究了在母乳喂养期间是否可以确定母亲控制的差异，以及为什么会发生这种关系。在一项纵向研究中，母乳喂养的母亲更有可能根据婴儿的需求喂养，而配方奶喂养的母亲更有可能按照时间表喂养并控制摄入量。重要的是，产妇控制与对母乳喂养的态度有关。认为母乳喂养不方便或困难的母亲更有可能控制喂养方式并使用配方奶粉喂养。这些态度存在于产前，并预测母乳喂养持续时间。值得注意的是，开始母乳喂养但对喂养频率和牛奶摄入量高度关注的母亲更有可能停止母乳喂养并加强控制。配方喂养允许更好的控制和常规。这可能会对婴儿健康产生不利影响，因为母乳喂养时间缩短，会影响婴儿自我调节能量摄入的能力，从而导致超重。这项研究对了解母乳喂养持续时间和儿童超重的影响具有重要意义，这是主要的公共卫生问题。该研究金的目的是通过出版物、会议演讲和学术界和卫生专业人员的学习日来传播研究结果。这将允许对该领域进行进一步的研究，并确保将研究结果直接提供给那些致力于提高母乳喂养率的人。关键信息可用于直接制定干预措施，以支持孕妇和新妈妈，特别是在产前开展工作，以提高对婴儿主导的母乳喂养的正常和必要性的认识和信心。研究结果可用于为支持母乳喂养的循证政策提供信息。因此，研究金的受益者不仅包括学者，还包括保健专业人员、母亲和婴儿以及一般公众，因为母乳喂养率可能会增加，这反过来对公共卫生产生积极影响，从而对国民保健制度的成本和资源产生积极影响。总的来说，这项研究是高度相关的，可能会改善婴儿和孕产妇的健康。

Levels of childhood obesity are increasing in the UK placing children at risk of current and future health problems with a significant impact upon NHS resources. Children from lower socioeconomic backgrounds are at increased risk. Childhood nutrition is a major risk factor for overweight and therefore early interventions to reduce obesity risk are needed. Individuals who recognise when they are full and do not overeat are more likely to be a healthy weight. Differences in this ability can be recognised from childhood. One influence upon this ability is the amount of control a mother exerts over her child's eating. Children have an innate ability to regulate intake of food but behaviours such as restricting intake or pressurising the child to consume more may lead to issues with eating style and overweight. Mothers who breastfeed use lower levels of control over their child's later diet. It has been hypothesised (but not examined) that differences in the feeding style of breast and formula fed infants may explain this. Breastfeeding is more 'baby-led' than formula feeding. The amount of milk consumed cannot be easily measured and feeds are frequent and irregular to stimulate milk supply. Conversely formula feeding is more visible and usually performed to a schedule. It is much easier to track amount of milk consumed. Whilst mothers who breastfeed need to follow their baby's cues to feed, formula feeding mothers have greater control and opportunity to manipulate intake. These differences may follow through into later feeding style. Alternatively mothers who desire a high level of control over feeding in general may choose to formula feed due to greater opportunity to manipulate feeding and go on to exert higher levels of control over later diet. My PhD research explored this relationship examining whether differences in maternal control could be identified during milk feeding and why any relationship might occur. In a longitudinal study, mothers who breastfed were more likely to feed to infant demand whilst mothers who formula fed were more likely to feed to a schedule and manipulate intake. Importantly, maternal control was associated with attitudes towards breastfeeding. Mothers who believed breastfeeding was inconvenient or difficult were more likely to control feeding patterns and to formula feed. These attitudes were present prenatally and predicted breastfeeding duration. Notably, mothers who started breastfeeding but held high concerns about feeding frequency and milk intake were more likely to stop breastfeeding and increase control. Formula feeding allowed greater control and routine. Potentially this is having an adverse effect upon infant health, through a shorter breastfeeding duration and impact upon ability to self regulate intake of energy leading to overweight. The research has important consequences for understanding influences upon breastfeeding duration and child overweight which are key public health concerns. The aim of the fellowship is to disseminate findings, through publications, conference presentations and study days for both academics and health professionals. This will allow further research into the area to be conducted and ensure findings are given directly to those working to increase breastfeeding rates. Key messages could be used to directly develop interventions to support pregnant and new mothers, particularly working antenatally to increase knowledge and confidence of the normality and need for baby-led breastfeeding. Findings could be used to inform evidence based policy in supporting breastfeeding. Beneficiaries of the fellowship would therefore include not only Academics but Health Professionals, Mothers and Infants and the General Public through potential increases in breastfeeding rates which in turn have a positive impact upon Public Health and thus NHS costs and resources. Overall the research is highly relevant, potentially improving both infant and maternal health.