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- W2795689009 abstract "Maternal & Child NutritionVolume 14, Issue S2 e12587 SUPPLEMENTARY ARTICLEFree Access Abstracts First published: 14 March 2018 https://doi.org/10.1111/mcn.12587Citations: 2AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Impact of vitamin D supplementation during lactation on infants' vitamin D status F. Aghajafari1, C.J. Field2 and A.R. Weinberg2 1Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; 2Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada Corresponding author: F. Aghajafari, E-mail: Fariba.aghajafari@ucalgary.ca Vitamin D has a role in fetal and infant skeletal development, and exclusively breastfed infants who are not supplemented with vitamin D are at increased risk for both insufficient vitamin D and calcium and the resulting short- and long-term health consequences (Mahon et al., 2010). The breast milk content of vitamin D is very much dependent on maternal vitamin D status, and it can be improved by maternal intake and/or increased maternal dermal synthesis (Hollis & Wagner, 2004). There is evidence that fetal skeletal development is enhanced by vitamin D supplementation, although the effective daily dose for infants is not clear (Gallo et al., 2016). The overall objective of this study was to determine the association between estimated maternal vitamin D intake (from both diet and supplements) during lactation with vitamin D status in exclusively breastfed infants at 3 months of age. We undertook a secondary analysis of an established maternal and infant prospective cohort study. The Alberta Pregnant Outcomes and Nutrition (APrON) cohort is a study of approximately 2,200 Albertan women and their children that was initiated in 2009. We used the APrON cohort data and analysed the banked blood samples collected from a subset of infants (250) at 3 months of age. All frozen collected plasma was assayed using LC-MS/MS (liquid chromatography–tandem mass spectrometric), and concentrations of 25(OH)D2, 25(OH)D3, and 3-epi-25(OH)D3 were determined. Maternal dietary data were obtained from questionnaires including a Supplement Intake Questionnaire (SIQ) and 24-hr recall of the previous day's diet collected as part of the APrON. The cohort was primarily Caucasian (82%) with the mean age of 31 ± 4 and pre-pregnancy BMI of 24.2 ± 4.7. Fifty-eight percent of participants were primiparous, 60% had trade or university degree, and 60% had income higher than $CAN 100,000. The median maternal vitamin D intake form diet, supplements, and both were 184, 400, and 665 IU/day, respectively. Fifty-five percent of infants were male, with the mean birthweight of 3285.6 ± 659 g, and more than 80% were taking vitamin D supplements. Seventy-two percent of infants were breastfed, 11.5% were formula fed, and 16% were both breastfed and formula fed. 25(OH)D2, 25(OH)D3, and 3-epi-25(OH)D3 were all identified in 250 plasma samples at 3 months of age, and 3-epi-25(OH)D3 contributed 15% of the total vitamin D. Infants' median (25(OH)D2 + 25(OH)D3) was 94.3 (74.1 to 114.1), and 25% of infants had 25(OH)D concentration < 75 nmol/l. There was a positive correlation between maternal dietary vitamin D intake (diet and supplements) at post-partum and infants' plasma 25(OH)D and 3-epi-25(OH)D3 concentration in those infants who were breastfed only, at 3 months of age (r = 0.18, p = .02 and r = 0.27, p = .01, respectively). We found that 25% of infants would be considered vitamin D deficient/insufficient by current standards (<75 nmol/l), although majority of infants were given a vitamin D supplement. Approximately 70% of these infants were exclusively breastfed and rely on their mothers' vitamin D intake. However, our analysis of lactating mothers in APrON has shown that 23% of them do not meet the estimated average range (EAR: 400 IU/day). The Dietary Reference Intake for vitamin D may not be optimal for lactating mothers, and they need to be encouraged to take higher doses of vitamin D for their infants' health. REFERENCES Mahon, P., Harvey, N., Crozier, S., Inskip, H., Robinson, S., Arden, N., … SWS Study Group. (2010). Low maternal vitamin D status and fetal bone development: Cohort study. Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research, 25, 14– 19. Hollis, B. W., & Wagner, C. L. (2004). Vitamin D requirements during lactation: High-dose maternal supplementation therapy to prevent hypovitaminosis D for both the mother and the nursing infant. The American Journal of Clinical Nutrition, 80(suppl 6), 1752S– 1758S. Gallo, S., Hazell, T., Vanstone, C. A., Agellon, S., Jones, G., L'Abbé M., Rodd C., Weiler, H. A. (2016). Vitmain D supplementation in breastfed infants from Montréal, Canada: 25-hydroxyvitaminD and bone health effects from a follow-up study at 3 years of age. Osteoporosis International, 27, 2459– 2466. Cessation of exclusive breastfeeding; an Australian cross-sectional survey J. Ayton1,2,3, L.V.D. Mei3, E. Hansen2, M. Nelson3 and K. Wills3 1School of Health Sciences, University of Tasmania Faculty of Health, Hobart, Australia; 2University of Tasmania School of Social Science, Hobart, Australia; 3Menzies Institute for Medical Research Tasmania, Hobart, Australia Corresponding author: J. Ayton, E-mail: Jennifer.ayton@utas.edu.au Exclusive breastfeeding (breast milk only) is rare in many settings. This is despite significant health benefits associated with sustained exclusive breastfeeding and the global recommendation of extended exclusive breastfeeding for infants to “about” 6 months (World Health Organization/UNICEF, 2012). Breastfeeding patterns are not distributed equally across populations; instead, they are socially patterned and complex (Bhutta & Salam, 2012). How the factors known to affect breastfeeding might impact the early interruption of exclusive breastfeeding (through the feeding of other fluids or foods) is unclear because of knowledge gaps. To address this, we estimated the prevalence and key risk factors associated with cessation of exclusive breastfeeding within the first 6 months using a national representative sample of 22,202 mother and infant pairs derived from the 2010 Australian Institute of Health and Welfare cross-sectional survey, the Australian Infant Feeding Survey (Ayton, van der Mei, Wills, Hansen, & Nelson, 2015). Among those who initiated exclusive breastfeeding at birth, 49% of infants ceased exclusive breastfeeding before they had reached 2 months of age. In the final Cox proportional hazards multivariate model, cessation of exclusive breastfeeding was most strongly associated with partners preferring bottle-feeding (HR 1.85, 95% CI [1.69, 20.6]) or having no preference (HR 1.37, 95% CI [1.33, 1.42]), regular dummy use (HR, 1.35, 95% CI [1.31, 1.39]), and maternal obesity (HR 1.29, 95% CI [1.24, 1.35]). Living within the most disadvantaged areas of Australia (Quintile 1) was not strongly associated with cessation (HR 1.08, 95% CI [1.02, 1.14]) compared with least disadvantaged areas. The prevalence of cessation of excusive breastfeeding in the first 6 months is high. This is the first time a sample of this size has been used to estimate the prevalence of exclusive breastfeeding and the key factors associated with cessation of exclusive breastfeeding. Among a sample of mothers and their infants who initiated exclusive breastfeeding at birth, 50% of mothers had ceased exclusive breastfeeding within the first 2 months of an infant's life. There is an urgent need to re-examine how exclusive breastfeeding is promoted, and what supports women and their families need to continue breastfeeding. While multiple factors are associated with cessation, the fathers' infant feeding preference and regular dummy use appear to be most strongly associated with early cessation of exclusive breastfeeding. This is an exciting finding as it suggests that fathers' views have a significant impact on infant feeding practices. Dummy use is perhaps a symptom of other feeding or settling problems. Early cessation of exclusive breastfeeding appears to be a symptom of the accumulation of factors, many of which are outside the mother's control (partner's preference, method of birth, socio-economic indicators for areas, age, and perinatal depression). Engaging and supporting fathers/partners to understand the importance of exclusive breast feeding is essential if we are going to reduce the high proportion of mothers interrupting exclusive breast feeding within the first 6 months. Indeed, the greatest public health impact is most likely to be achieved when multiple risk factors are modified or prevented. REFERENCES Ayton, J., van derMei, I., Wills, K., Hansen, E., & Nelson, M. (2015). Cumulative risks and cessation of exclusive breast feeding: Australian cross-sectional survey. Archives of Disease in Childhood. https://doi.org/10.1136/archdischild-2014-307833 Bhutta, Z. A., & Salam, R. A. (2012). Global nutrition epidemiology and trends. Annals of Nutrition & Metabolism, 61 Suppl 1, 19– 27. World Health Organization/UNICEF. (2012). Global strategy on infant and young child feeding. Retrieved from http://www.who.int/maternal_child_adolescent/documents/9241562218/en/ Mothers' experiences of interrupting exclusive breastfeeding; a qualitative study J. Ayton1,2,3, E. Hansen2 and M. Nelson3 1School of Health Sciences, University of Tasmania Faculty of Health, Hobart, Australia; 2University of Tasmania School of Social Science, Hobart, Australia; 3Menzies Institute for Medical Research Tasmania, Hobart, Australia Corresponding author: J. Ayton, E-mail: Jennifer.ayton@utas.edu.au Non-fatal and fatal disease burden due to the lack of exclusive breastfeeding (only breast milk) is a serious public health concern (Victora et al., 2016). While this field of research remains under-theorised, the evidence suggests that mothers do not breastfeed in isolation but in relation to their social context and the social, cultural, and economic resources available to them (Liamputtong, 2010). This paper seeks to explore women's day-to-day experiences of breastfeeding and to illuminate some of the complexities, and contradictions that lead to the interruption of exclusivity, chiefly through the feeding of infant formula milks using sociologist Pierre Bourdieu's (1990) “theory of practice.” Bourdieu's theory consists of three concepts: habitus (set of depositions), capital (resources), and field (the social arena in which practices are generated). Practices (what we do) are generated from the interactions between habitus, field, and capital (Bourdieu, 1990). We undertook a qualitative study involving 108 mothers from 22 focus groups conducted between November 2011 and August 2012 in northern and southern Tasmania, Australia. A broad demographic of Tasmanian mothers and their infants/children aged between 0 and 36 months voluntarily consented to participate. The data were analysed thematically using the sociological theory of Pierre Bourdieu. The analysis generated three key themes: value (habitus), allofeeding (capital), and endurance (field) = disjuncture (practices). All 108 women in the study highly valued breastfeeding and breast milk as natural. Mothers did not spontaneously talk of or appear to understand the term “exclusive breastfeeding.” Instead, they consciously set out to “just breastfeed.” The findings of this research suggest that the values attached “to breastfeed” as being “natural” and “best” are internalised by the women as historical and familial dispositions belonging to the habitus which unconsciously guide mothers' breastfeeding choices and practices. The practice of breastfeeding for most of the mothers in this study was based upon a contemporary form of allofeeding, in which they engaged a variety of physical capitals aside from their own breasts and breast milk, bottles, dummies, and partners/father of the infant to complement their breastfeeding practices and to carry out their role as breastfeeding mothers. In this way, mothers are partaking in an endurance race “to breastfeed” as part of the social arena of motherhood. Infant formula milks are types of capital and have a powerful presence in the field of motherhood, with most of the women using infant formula milks during their breastfeeding experience. The research highlights the disjuncture between the habitus—mothers' value in “to breastfeed”—and the social field where infant formula milks are an accepted form of capital and practice. This leads to a metaphorical and physical separation between the mother, her breasts, nipples, and importantly the infant accounting for “feeling a failure.” Finally and importantly, women set out “to just breastfeed” and do not consciously experience exclusive breastfeeding as a feeding practice; instead, mothers negotiate and dance with using infant formula milk as a way of making sense of disjuncture and feelings of failure. This research contributes by exploring how women understand what exclusive breastfeeding is and offers insight into some of the complexities and social practice of breastfeeding, and the use of infant formula milks. REFERENCES Bourdieu, P. (1990). The logic of practice. Cambridge: Polity. Liamputtong, P. (2010). Infant feeding practices: A cross-cultural perspective: Springer Science & Business Media. Victora, C. G., Bahl, R., Barros, A. J., Franca, G. V., Horton, S., Krasevec, J., … Rollins, N. C. (2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. Lancet, 387(10017), 475– 490. Infant sleep and breastfeeding in a culturally derived sleep device (wahakura) compared with a standard bassinet—A randomised controlled trial S. Baddock1, D. Tipene-Leach2, S. Williams3, A. Tangiora2, R. Jones2 and B. Taylor2 1School of Midwifery, Otago Polytechnic, Dunedin, New Zealand; 2Women's and Children's Health Network, Adelaide, Australia; 3Preventive & Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand Corresponding author: S. Baddock, E-mail: Sally.baddock@op.ac.nz In New Zealand, Māori, like many indigenous people, place a cultural value on bedsharing as a way of facilitating breastfeeding and attachment (Tipene-Leach et al., 2010). Objective overnight infrared video recordings have identified increased breastfeeding episodes during bedsharing compared to solitary sleeping (Baddock, Galland, Bolton, Williams, & Taylor, 2006). However, bedsharing is associated with increased risk of sudden unexpected death in infancy (SUDI), particularly if the mother smoked in pregnancy. In New Zealand, the Māori SUDI rate is 5 times that of non-Māori, non-Pacific (2.34 deaths per 1,000 live births vs. 0.52; Child and Youth Mortality Review Committee, 2009), and many of these deaths are associated with bedsharing after exposure of the infant to the effects of cigarette smoking in utero. The wahakura (flax bassinet) originated from the Māori community as a potentially safer sleep place to use on the adult bed from birth, but to date, there has been no assessment of its safety. The aim of this study was to compare wahakura with bassinets to identify potential advantages such as breastfeeding duration; and potential risks such as head-covering, prone sleep position, and time bedsharing; and other factors such as total sleep time and mother–baby interactions. Two hundred participants were recruited, through midwifery practices supporting mainly Māori families in more deprived areas, and were randomised to receive a wahakura (W) or a bassinet (B) during pregnancy. Questionnaires were completed at baseline, 1, 3, and 6 months. Overnight infant sleep studies using infrared video, and physiological measures of temperature and SaO2 were completed at 1 month. Video data were analysed using a taxonomy to identify predetermined infant behaviours. Intention to treat analysis was used. Increased full breastfeeding was reported at 6 months by the wahakura group compared to the bassinet group (11%B vs. 23%W, p = .04). On the study night, mean head covered time (B:0.45 vs. W:0.43 hr) and breastfeeding (B:0.38 vs. W:0.44 hr) were not significantly different. Nor were the number of head covering (mean, B:2.1 vs. W:1.5, p = .4) and breastfeeding events (B:3.2 vs. W:3.9, p = .3) or maternal–baby interactions. Time bedsharing (B:1.7 hr vs. W:2.1 hr, p = .48) was similar. Babies slept in the bassinet (mean, B:6.7 hr vs. W:1.9 hr, p < .0001) and slept in the wahakura (B:0 vs. W:4.2 hr), while study time (B:9.9 vs. 10.1 hr) and asleep time (B:6.7 vs. W:6.7) were not significantly different between groups. Allocation of a wahakura was associated with increased full breastfeeding at 6 months, although on the study night there was no increase in mother–baby interactions, time bedsharing, or any other behaviours measured on the study night. This study suggests that it is as reasonable to provide a wahakura as it is to provide a bassinet as a safe sleep intervention in this population with the added advantage of increased duration of breastfeeding. REFERENCES Baddock, S. A., Galland, B. C., Bolton, D. P., Williams, S. M., & Taylor, B. J. (2006). Differences in infant and parent behaviors during routine bed sharing compared with cot sleeping in the home setting. Pediatrics, 117(5), 1599– 1607. Child and Youth Mortality Review Committee, Te Ròpù Arotake Auau Mate o te Hunga Tamariki, Taiohi. (2009). Fifth report to the Minister of Health: Reporting mortality 2002–2008. Wellington, New Zealand Tipene-Leach, D., Hutchison, L., Tangiora, A., Rea, C., White, R., Stewart, A., & Mitchell, E. (2010). SIDS-related knowledge and infant care practices among Maori mothers. New Zealand Medical Journal, 123(1326), 88– 96. Listening to pregnant women's views on nutritional information in pregnancy E. Bailey1, S. Lees2, S. Law2, I. McDermott2, S. Durnan2, C. Clowes2, E. Clarke2, B. Norman2, C. Mackay2, H. Flaherty2 and J. Coad2 1Coventry University and UHCW NHS Trust, Coventry, UK; 2Coventry University, Coventry, UK Corresponding author: E. Bailey, E-mail: elizabeth.bailey@coventry.ac.uk In previous years, we have delivered antenatal education to pregnant women in Coventry and conducted an evaluation of the service. Part of the feedback from that evaluation was a request for greater information on nutrition (Coad, 2014). Olander et al. (2012) found that women were most receptive to signposting and advice on nutrition delivered through health professionals but wanted further information beyond leaflets. They wanted more practical advice and indicated that practical sessions aimed at pregnant women would be welcome. Although one to one, face to face may seem attractive, in reality, it may be difficult to ensure contemporaneous advice is given in a consistent manner across maternity services. Nutritional information is currently provided in leaflet form to pregnant women with NHS endorsed information available online which focuses on broad nutritional advice (NHS Choices, 2016). Healthy recipes are available through the Fit4Life platform and a recently added Start4Life booklet for pregnancy. There is little understanding of the impact of this written information on women's views and understanding of nutrition. Whether they receive this information may depend on ad hoc local practices or rely on women seeking out this information on their own. The aim of the event was to get a snapshot of the capacity of the service users with a regard to knowledge and activities around nutrition and diet for a healthy pregnancy, together with their views on current resources and how additional resources would support their nutritional needs. Using an approach modelled on community asset mapping, a “World Cafe” style listening event was held in communal areas of a large city maternity hospital. Women attending the maternity unit were invited to engage in active listening exercises with one of four midwives, to understand existing knowledge, and feedback on advice received in pregnancy. Written consent for participation was obtained, and a short semi-structured interview was undertaken. Analysis was undertaken for recurring issues that influenced dietary choices and behaviours in pregnancy. In addition, participants were invited to take part in creative exercises. Each participant was given a paper plate and a pen and asked to draw a “pie chart” that showed what influenced them in choosing how to eat in pregnancy; the larger the “wedge,” the more the influence. Each “plate data” was measured with a protractor for quantification by degrees afforded to each wedge, then normalised to % of total. The event engaged with 17 women and captured a range of demographics (Table1). Women had been given a variety of leaflets (15/17), but they had mostly been given with no further discussion (14/15). A number of women (14/17) had looked online or used Apps to seek further information on nutrition. A number of recurring themes were identified in semi-structured interviews including cravings, aversions, and changing tastes and appetites across all trimesters including a change in attitude from first pregnancy to subsequent pregnancies. A strong recurring theme was food safety with many women discussing their apprehensions about what foods were “allowed” in pregnancy, and this was also mentioned (7/17) as something women would have liked further information on. Weight was not an issue raised by women frequently (2/17). When the paper plates were analysed, family favourite recipes, healthy choices, and media influences were in the top three factors influencing decisions on what to eat. Table 1. Demographics and characteristics of participants Characteristic N = 17 English not 1st language 4 (23.5%) Dyslexic 1 (5.9%) 1st baby 5 29.4 Vegetarian 2 11.8 Gestational diabetic 1 5.9 Assisted reproduction 2 11.8 Antenatal 7 41.2 Immediate post-natal 10 58.8 In conclusion, women seemed to approach their food choices in pregnancy from the perspective of avoiding “unsafe” or “undesirable” foods. There was a sense that women were modifying their usual diet in pregnancy by excluding foods for the safety of the baby. What did not seem to emerge is evidence from the interviews of women making positive and additive health choices to their diet. It was not clear whether this attitude was driven by the avoidance nature of the current information they receive or if it is driven by a desire to protect the pregnancy over promoting self-well-being. The time when this was “over-ruled” was when aversions or cravings directed their choices and this appeared to vary across all trimesters. Future work will focus on more detailed exploration of women's attitudes to adapting diet in pregnancy and exploring the development of novel nutritional information delivery that appreciates pregnancy cravings, aversions, and changing preferences. REFERENCES Coad, J. (2014). The Antenatal education programme final report On behalf of Coventry University midwifery dept (internal document Coventry University) Olander, E. K., Atkinson, L., Edmunds, J. K. & French, D.P. (2012). Promoting healthy eating in pregnancy: What kind of support services do women say they want? Primary Health Care Research and Development, 13(3), 237– 243. NHS Choices. (2016). Have a healthy diet in pregnancy. Available from: http://www.nhs.uk/conditions/pregnancy-and-baby/pages/healthy-pregnancy-diet.aspx. Ifeed: Development of a tailored digital intervention to support parent-infant bonding and enable confident and safe infant feeding N. Bartle1, K. Brown1, S. Law1, L. Moody1, J. Dale2 and K. Gokal1 1Coventry University, Coventry, UK; 2University of Warwick, Coventry, UK Corresponding author: N. Bartle, E-mail: Naomi.bartle@coventry.ac.uk Although breastfeeding is biologically normal, rates in the United Kingdom are among the lowest in the world, which has a significant negative impact on public health. Evidence suggests that the “breast is best” message is reaching parents, but that many mothers do not reach their breastfeeding goals due to a complex milieu of physical, psychological, and social barriers (Brown, 2016). Mothers most often report stopping breastfeeding earlier than intended due to difficulties that could have been prevented or resolved with skilled support, but significant resource limitations mean that this support is difficult to access for some parents at the appropriate time. Many parents (regardless of age or socio-demographic status) report looking online for information about breastfeeding and/or social support but find it difficult to determine what is reliable, usable, and evidence based. Typically, existing websites offer medicalised information about breastfeeding but offer less information to empower parents to manage the social and psychological barriers to breastfeeding. For those who do not wish to breastfeed, or encounter insurmountable difficulties, the most commonly practiced alternative is to offer formula milk by bottle. Parents report difficulties accessing timely and independent guidance about bottle feeding which may contribute to unsafe practices (Lakshman, Ogilvie, & Ong, 2009). Furthermore, bottle-feeding parents may miss out on messages that encourage a responsive style of feeding and promote parent–infant bonding. The aim of this research is to develop an inclusive, digital intervention to support parents to make confident choices around infant feeding, to help parents overcome barriers to breastfeeding, and to enable safe and responsive bottle feeding when it is required. The aim is to provide content for fathers or partners, other family/friend supporters, and health professionals, as well as content directed to mothers. We have taken a systematic, iterative approach to intervention development, including the following stages: (a) needs assessment including a literature review, review of existing digital interventions, and focus groups with parents and health care staff; (b) behavioural analysis and selection of behaviour change techniques using the behaviour change wheel (Michie, Atkins, & West, 2014); and (c) consultation with target users (n = 20) throughout the process. The needs assessment indicated that although there were many digital interventions available, few were systematically developed, inclusive of both breastfeeding and bottle-feeding information or attempted to empower parents to manage the social and psychological barriers to breastfeeding. Behavioural analysis showed that although mothers may be motivated by the health consequences associated with breastfeeding, they may also perceive it as effortful and difficult, particularly alongside competing social expectations. Mothers may also need support to manage the emotional consequences of not meeting their personal breastfeeding goals. Health professionals were concerned about providing bottle feeding information alongside breastfeeding information for fear of them appearing equal and ensuring consistency with UNICEF Babyfriendly guidelines. The first content a user will see focuses on promoting parent–infant bonding via infant feeding. The prototype website will then allow for users to receive personalised information and behaviour change techniques targeted to their current situation and feelings around infant feeding. Specific content areas include breastfeeding and lifestyle changes, managing body image concerns and breastfeeding in public, health consequences of breastfeeding, managing milk supply and demand, overcoming breastfeeding difficulties, sterilisation of bottle feeding equipment, responsive bottle feeding, preparing and storing bottles, information for fathers, and other supporters around infant feeding and bonding, best practice guidelines around weaning, where to find support for infant feeding. The prototype intervention is currently being tested for usability and acceptability before making further refinements. REFERENCES Brown, A. (2016). Breastfeeding uncovered: Who really decides how we feed our babies?. Pinter & Martin, UK. Lakshman, R., Ogilvie, D., & Ong, K. K. (2009). Mothers experiences of bottle-feeding: A systematic review of qualitative and quantitative studies. Archives of Disease in Childhood 94: 596– 601. Michie, S., Atkins, L. & West R. (2014). The behaviour change wheel: A guide to designing interventions. Silverback publishing; UK Designing interventions to improve linear growth in young children: Opportunities and challenges N. Bhandari Centre for Health Research and Development, Society for Applied Studies, New Delhi, India Corresponding author: N. Bhandari, E-mail: nita.bhandari@sas.org.in The goal of a nutrition programme is to have 2-year-olds who do not have stunting or wasting or impaired cognition and have an adequate body content of critical vitamins and micronutrients. There is wide consensus that the design, content, and delivery of programmes to reduce stunting in under-2s require re-examination and" @default.
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