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

儿童肥胖的水平正在增加，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大。儿童营养是超重的主要风险因素，因此需要早期干预以降低肥胖风险。那些能意识到自己吃饱了而不暴饮暴食的人更有可能拥有健康的体重。这种能力的差异可以从童年时期就被认识到。影响这种能力的一个因素是母亲对孩子饮食的控制程度。儿童具有调节食物摄入量的先天能力，但限制摄入量或迫使儿童消费更多等行为可能会导致饮食风格和超重问题。母乳喂养的母亲对孩子以后的饮食控制水平较低。有人假设（但未经检验），母乳喂养和配方奶粉喂养的婴儿喂养方式的差异可能解释了这一点。母乳喂养比配方奶粉喂养更“婴儿主导”。牛奶的消耗量不易测量，并且经常和不定期地喂食以刺激牛奶供应。相反，配方奶喂养更明显，通常按照时间表进行。更容易跟踪牛奶的消耗量。虽然母乳喂养的母亲需要遵循婴儿的暗示来喂养，但配方奶粉喂养的母亲有更大的控制权和机会来操纵摄入量。这些差异可能会延续到以后的喂养方式。或者，希望对喂养进行高水平控制的母亲通常可以选择配方饲料，因为有更大的机会操纵喂养，并继续对以后的饮食进行更高水平的控制。我的博士研究探讨了这种关系，研究是否可以在母乳喂养过程中确定产妇控制的差异，以及为什么可能发生任何关系。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，而配方奶粉喂养的母亲更有可能按照时间表喂养并操纵摄入量。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模式和配方饲料。这些态度是目前产前和预测母乳喂养的持续时间。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。配方喂养允许更大的控制和常规。这可能会对婴儿的健康产生不利影响，通过缩短母乳喂养时间和影响自我调节能量摄入的能力，导致超重。这项研究对于理解母乳喂养持续时间和儿童超重的影响具有重要意义，这是关键的公共卫生问题。研究金的目的是通过出版物、会议介绍和学术界和卫生专业人员的学习日传播研究结果。这将有助于对该领域进行进一步研究，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，以支持孕妇和新生儿母亲，特别是产前工作，以增加对婴儿主导的母乳喂养的正常性和必要性的知识和信心。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，奖学金的受益者不仅包括学术界人士，还包括卫生专业人员、母亲和婴儿以及公众，因为母乳喂养率可能会增加，这反过来又会对公共卫生产生积极影响，从而对国民保健服务的成本和资源产生积极影响。总的来说，这项研究具有高度相关性，可能改善婴儿和产妇的健康。

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.