CURRENT PRACTICE AND WEANING ATTITUDES FOR INFANTS AT HIGH RISK OF ADVERSE FOOD REACTIONS. Josephine Calarco BSc. Allergy Unit Department of Clinical Immunology Royal Prince Alfred Hospital. Research Supervisors: Dr. Velencia L Soutter MBBS, FRACP Paediatrician Allergy Unit Department of Clinical Imrmmol ogy Royal Prince AJfred Hospital. Dr. Anne R Swain Dip Nutr Diet, PhD Chief Dietitian Allergy Unit Department of Clinical Immmrology Royal Prince Alfred Hospital. Dr. Robert H Loblay MBBS PhD FRACP Director Allergy Unit Department of Clinical Immmrology Royal Prince AJ. fred Hospital. Research Co - Supervisor: Prof. A. Stewart Truswell. Human Nutrition Unit Department of Biochemistry University of Sydney.
66
Embed
CURRENT PRACTICE AND WEANING ATTITUDES FOR … · CURRENT PRACTICE AND WEANING ATTITUDES ... is early weaning due to breast ... Weaning practices: Reasons for weaning …
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
CURRENT PRACTICE AND WEANING ATTITUDES
FOR INFANTS AT HIGH RISK OF ADVERSE FOOD REACTIONS.
Josephine Calarco BSc.
Allergy Unit Department of Clinical Immunology
Royal Prince Alfred Hospital.
Research Supervisors: Dr. Velencia L Soutter MBBS, FRACP
Paediatrician Allergy Unit
Department of Clinical Imrmmology Royal Prince AJfred Hospital.
Dr. Anne R Swain Dip Nutr Diet, PhD Chief Dietitian Allergy Unit
Department of Clinical Immmrology Royal Prince Alfred Hospital.
Dr. Robert H Loblay MBBS PhD FRACP Director Allergy Unit
Department of Clinical Immmrology Royal Prince AJ.fred Hospital.
Research Co - Supervisor: Prof. A. Stewart Truswell.
Human Nutrition Unit Department of Biochemistry
University of Sydney.
Acknowledgements:
My sincerest appreciation and thanks to Dr. Velencia Souter, Dr. Anne Swain, Dr. Robert Loblay and Prof A. Stewart Truswell, for giving me the opportumty to do this project with them, for giving me the opportunity to team a range of valuable research skiffs and for providing their nutritional and medical expertise.
A special thanks to: Dr. Vefencia Sautter for her knowledge, imagination, valuable time and allowing me to sit in with her patients which were the
~ inspiration for this study; Dr. Anne Swain for her constant support and guidance; Dr. Robert Loblay for his final and rigorous scrutiny of both the survey and the report; Prof A. Stewart Truswell for monitoring the study and qffering suggestions; and all the staff at the Clinic for treating me warmly and professionally.
Being part of the Clinic has shown me 1hat being part of a team is an effective way of complementing the knowledge, experience, talents and skills of various people, and that being part of a team does not diminish your value or contribution to a task - on the contrary, it challenges you to do your best. In the words of a famous author:
"Two are better !han one, because they have a good reward for their labour. For if they fall, the one will /if' up his fellow, bul woe to him thai is alone when he falleth, for he hath not another to help him up. "
(John Steinbeck, "The Grapes OfWrath")
Josephine Calarco. 4 June, 1995.
-
Declaration:
I, ................................................ , hereby declare that none of the work presented
in this essay has been submitted to any other University or Institution for a higher
degree and that to the best of my knowledge contains no material written or
published by another person, except where due reference is made in the text.
This study was a survey of health professionals and did not involve contact with
research subjects. After consultation with the chainnan ofthe Research Ethics
Committee, RP AH, I was advised that Ethical Approval was not required.
Signature:
Date:
• • • I I
TITLE:
Current practice and weanmg attitudes for infants at high risk of adverse food
reactions.
INTRODUCTION:
Previous work at the Al lergy Unit of the R.P.A.H Medical Centre (Loblay & Swain
1986) has shown that dietary factors (salicylates, arnines, MSG, colours, flavours and
preservatives) can provoke irritability and diarrhoea in food sensitive infants, and that
allergenic foods in high-risk individuals can provoke eczema. These observations
together with results in the literature ofthe effect of maternal diet (Gerrard & Shenassa
1983), suggest that food intolerance should be investigated in cases of colic and
frequent loose stools, and food allergy in cases of eczema.
The Allergy Unit has investigated over 2,000 children with various symptoms over the
past I 5 years. Many children present with a range of symptoms and have a history of
food related symptoms that have staned in infancy. Breast-feeding mothers of colicky
infants who come to the Clinic often repon that other health professionals believe that
they are being over-anxious, and that the foods in their diet bear little or no relevance
to the baby's symptoms. Another common scenario amongst mothers of colick")' infants
is early weaning due to breast-feeding problems. These mothers wean their infant onto
cow's milk based formula, only to find little or no improvement, and although the
introduction of soy based formula often leads to a dramatic improvement, the
introduction of solids again elicits symptoms in the baby. Lactose is usually
incriminated with frequent loose stools, and so mothers often present with a history of
having tried lactaid® drops with breast feeds, or with the baby weaned onto low
lactose or lactose-free formula, again with little no improvement in the infant. Mothers
of infants with eczema are often surprised to learn that diet plays a role in their infant's
eczema, and are resentful for not having been told the potential allergenic risk of
certain foods sooner by health professionals.
The study developed from an interest to determine how health professionals currently
diagnose and manage diet related problems in infancy. Colic, frequent loose stools and
eczema were the symptoms chosen for this study, since they represent the most
common complaints for which advice is sought at the Allergy Unit. Funhermore,
investigating the infant feeding advice given by health professionals would help assess
their understanding of food allergy, food intolerance and lactase deficiency.
The specific objectives of the study were to determine:
(i) the level of awareness by infant-care workers that the breast-feeding mother' s diet
may sometimes affect the infant;
(ii) the frequency with which the breast-feeding mother' s diet is implicated, and the
foods most often reported;
(iii) the frequency and reasons given for weaning in these circumstances;
(iv) whether the choice of weaning formulas reflected an understanding of potential
adverse food reactions in such infants.
2
DEFINITIONS:
In the literature, terms such as food reaction, food hypersensitivity, food allergy, food
sensitivity and food intolerance are often confused or are used interchangeably. In this
study, adverse reactions to foods have been classified as either (i) food allergy, or (ii)
food intolerance.
Food allergy is used to describe an IgE-mediated adverse reaction to protein foods,
one which usually causes immediate reaction, and requires avoidance of the food(s). It
usually occurs in infants and toddlers and results from sensitisation in the first few
months oflife. The skin prick test is a sensitive method of detecting lgE antibodies but
results must be interpreted in the clinical context. Although virtually any food is
potentially allergenic, in practice only a few foods (nuts, eggs, cow's milk, wheat, fish,
and soy products) commonly cause clinical allergies.
Food intolerance is used to describe a non-lgE mediated adverse reaction to food
chemicals(both natural and/or artificial), which usually cause delayed reactions.
Because the symptoms are dose related and cumulative, food intolerance involves
modifYing the whole diet to reduce the dose of food chernical(s) responsible for the
symptoms. It can occur in any age group and results from a genetic predisposition.
Food intolerance can only be confirmed from the recurrence of symptoms after
challenges while on an elimination diet.
3
METHODS:
1. Study Design:
The study involved conducting a national survey of the experiences of health
professionals concerning breast-feeding mothers' diet in relation to colic, loose stools
and eczema, and, if weaning was to occur, which formulas they would recommend.
The study also involved collating data from infant formula manufacturers to determine
the percentage consumption of various types of infant formula consumed by infants in
N .S.W. This information was used to compare with formulas recommended by health
professionals of the survey.
2. Setting:
The setting for the study was the Allergy Unit at the Royal Prince Alfred Hospital
Medical Centre, Newtown, N.S.W.
3. Participants:
The participants for the survey were the 3,551 Australian and New Zealand health
professionals who make up the subscribers of the "HeinzSight" newsletter put out by
H.J Heinz Company Australia Ltd. Among the subscribers were community and
pharmacy based child health nurses, dietitians, doctors, educators (in T AFE colleges
etc), nurses, and paediatricians. The number of each health profession who were
surveyed are shown below in Table I.
4
Table I : Number or each health profession who were surveyed
Soy formulas account for approximately 25% of all infant formula sales in the United
States and approximately 21% of sales in Canada (Neilsen Marketing Research,
1991). Data collected for this study shows that soy formulas account for approximately
15% of aU infant formula sales in N.S.W.
45
CONCLUSION:
The results of this study show that many breast-feeding mothers have observed and
reported that particular foods in their diet can cause symptoms in the baby. However,
the majority of health professionals are not diagnosing and managing colic and frequent
loose stools as food intolerance and are therefore not investigating the breast-feeding
mother's diet and/or making appropriate changes to the maternal diet. Similarly, many
health professionals do not seem to be aware of the importance of avoidance of
allergenic sources of foods in the breast-feeding mother's diet for the treatment of
eczema.
Although the choice of formula is an important issue for all infants, it is an especially
important issue in infants who have symptoms which may be due to adverse food
reactions. The results of this study suggest that formulas recommended by most health
professionals do not reflect an understanding that colic and frequent loose stools could
be due to food intolerance and that some health professionals are not aware of the
allergenicity of certain types of infant formula.
Further Acknowledgements:
I would like to acknowledge the cooperation of the following employees from infant formula manufacturers: Mary Jane Dwyer (Abbott Australasia Pty Ltd), Paula Davis (Douglas Phannaceuticals Aust Ltd), Jane Weir (Mead Johnson Australia), Robyn Edwards (Nestle Aust. Ltd), Jane Dibbs (Sharpe Laboratories Pty Ltd), and Leanne Spratt (Wyeth Phannaceuticals Pty Ltd).
46
REFERENCES:
Allen J. The feeding guide. Royal Alexandra Hospital for Children, Camperdown. Second Edition. 1993.
AMA Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics. 1989; 83: 1068 - 9.
Arshad SH, Manhews S, Gant C, Hide OW. Effect of allergen avoidance on development of allergic disorders in infancy. Lancet. 1992; 339: 1493-97.
Asnes R, Mones R. Infantile colic: a review. J ofDev. and Beh. Pediatrics. 1983; 4(1): 57 - 62.
Barr RG, McMullan SJ, Spieess H, Leduc DG, Yaremko J, Barfield R, Francoeur E, Hunziker UA. Carrying as colic " therapy": a randomized controlled trial. Pediatrics. 1991; 87(5): 623-630.
Barr RG, Woolridge J, Hanley J. Effects of formula change on intestinal hydrogen production and crying and fussing behaviour. J of Dev and Behav Pediatrics. 1991; 12(4): 248-253.
Barr RG, Rotman A, Yaremko J, Leduc D, Frncoeur TM. The crying of infants with coHc: a controlled empirical description. Pediatrics. 1992; 90(1): 14-21.
Birkbeck J. Weaning; a position statement. NZ Med J. 1992; I 05: 221-224.
Brazelton TB. Crying in infancy. Pediatrics. 1962; 29: 579- 588.
Bruce JW. Infantile colic. Pediatr Clin North Am. 1961; 8: 143 - 5.
Burks A W, Sampson HA. Diagnostic approaches to the patient with suspected food allergies. J Pediatr 1992; 121: S64-S7l.
Burks A W, Sampson H, Food Allergies in children. Curr Probl Pediatr. 1993; 23: 230-252.
Burr ML, Limb ES, Maguire MJ, Amarah L, Eldridge BA, Layzell JCM, Merrett TG. Infant feeding, wheezing, and allergy: a prospective study. Arch of Dis Child. 1993; 68: 724-728.
Businco L, Marchetti F, Pellegrini G, Cantani A, Perlini R. Prevention of atopic disease in ' at risk newborns' by prolonged breast feeding. Ann Allergy. 1983; 51 : 296 - 299.
Businco L, Cant ani A, Meglio P et al. Prevention of atopy: results of long-term (7 months to 8 years) follow up. Ann Allergy. 1987; 59: 183 - 186.
47
..
..
Businco L, Cantani A. Prevention of childhood allergy by dietary manipulation. Clin and Exper Allergy. 1990; 20(Supplement 3): 9-14.
Businco L, Bruno G, Giampietro PG, Cantani A. Allergenicity and nutritional adequacy of soy protein formulas. J Pediatr. 1992; 121 : S21-S8.
Carey WB. Maternal anxiety and infantile colic. Is there a relationship? Clin. Pediatrics. 1968; 7(10}: 590-595.
Carey WB. "Colic" - primary excessive crying as an infant-environment interaction. Pediatric Clinics ofNorth America. 1984; 31(5): 993-1005.
Chandra RK, Puri S, Hamed A. Influence of maternal diet during lactation and use of formula feeds on development of atopic eczema in high risk infants. Br Med J. 1989; 299: 228-230.
Chandra RK, Singh G, Shridhara B. Effect of feeding whey hydrolysate, soy and conventional cow milk formulas on incidence of atopic d isease in high-risk infants. Ann Allergy. 1989; 83 : I 02 - 6.
Chandra RK, Hamed A. Cumulative incidence of atopic disorders in high risk infants fed whey hydrolysate, soy, and conventional cow milk formulas. Ann Allergy. 1991; 67: 129-132.
Clein NW. Cow's milk allergy m infants and children. Int. Arch. Allergy App. Immunol. 1958; 13: 245 - 256.
Collins-Williams C. Incidence of milk allergy in pediatric practice. J. Pediatr. I 956; 48: 39 - 47.
Evans RW, Fergusson DM, Allardyce RA, Taylor B . Maternal diet and infantile colic in breast fed infants. Lancet. 1981 June 20; 1340 - 1342.
Falth-Magnusson K, Kjellman NIM. Allergy prevention by maternal elimination diet during late pregnancy - a 5 year follow-up of a randomized study. J. Allergy Clin. Tmmunol. 1992; 89(3}: 709-713.
Gerrard JW, Shenassa M. Sensitization to substances in breast milk: recognition, management and significance. Ann Allergy. 1983. 51; 300-302.
Gillies C. Infantile colic: is t here anything new? J. Pediatric Health Care. 1987; I (6): 305-312.
Glaser J, Johnstone DE. Prophylaxis of allergic disease in newborn. JAMA. 1953; 153: 620-622.
Hattevig G, Kjellman B. Sigurs N, Grodzinsky E, Hed J, Bjorksten B. The effect of maternal avoidance of eggs, cow's milk, and fish during lactation on the development oflgE, IgG, and IgA antibodies in infants. J Allergy Clio Immunol. 1990; 85: 108-115 .
48
Hill LW. Immunologic relationships between cow's milk and goat's milk J. Pediatr. 1939; 15: 157-62. Howie PW, Forsyth JS, Ogston SA, Clark A. Florey C. Protective effect of breast feeding against infection. Br Med J. 1990; 300: 11-16.
Iacono G, Carroccio A. Montalto G, Cavataio F, Bragion E, Lorello D, Balsamo V, Notarbartollo A. Severe infantile colic and food intolerance: a long-term prospective study. JPediatr Gastroenterol Nutr. 1991; 12(3): 332-335.
Jakobsson l , Lindberg T. Cow's milk as a cause of infantile colic in breast fed infants. Lancet. 1978 August 26; 2(8087): 437- 9.
Jakobsson I, Lindberg T. Cow's milk proteins cause infantile colic in breast fed infants: a double blind crossover study. Pediatrics. 1983; 71 : 268 - 271.
Johnstone DE, Dutton AM. Dietary prophylaxis of allergic disease in children. N Eng J Med. 1966; 274: 715-719.
Jorup S. Colonic hyperperistalsis in neurolabile infants. Acta Pediatrica. 1952; Suppl 85: I - 110.
Kjellman NI, Johansson SG. IgE and atopic allergy in newborns and infants with a family history of atopic disease. Acta Paediatr Scand. 1976; 65(5): 601-607.
Larsen JH. Infants' colic and belly massage. Practitioner. 1990 April 22; 234 (1487): 396-397.
Larson K, Ayllon T. The effects of contingent music and differential reinforcement on infantile colic. Behav. Res. Ther. 1990. 28(2): 119-125.
Lothe I, Lindberg T, Jakobsson I Cow's milk formula as a cause of infantile colic: a double blind study. Pediatrics. 1982; 70(1) : 7 - 10.
Mallet E, Henocq A. long term prevention of allergic diseases by using protein hydrolysate fonnula in at-risk infants. J Pediatr. 1992; 121: S95-S 100.
Matthew DJ, Taylor B, Norman PA, Turner MW, Soothill JF. Prevention of eczema. Lancet. 1977; 1: 32 1 -4.
49
Metcalf TJ, Irons TG, Sher LD, Young PC. Simelhicone in the treatment of infantile colic: a randomise<!, placebo-controlled, multicenter trial. Pediatrics. 1994; 94( I)· 29-34.
Miller JJ, McVeagh P, Fleet GH, Petocz P, Brand JC. Effect of lactase enzyme on "colic" in infants fed human milk. J Pediatrics. 1990; I 17(2): 26 1-263.
Miller JJ, McVeagh P, Fleet GH, Petocz P, Brand JC. Breath hydrogen excretion in infants with colic. Arch Dis Child. 1989; 64: 725-729.
Moore D. D avidson GP. Breath hydrogen response to milk containing lactose in colicky and noncolicky infants. J. Pediatrics. 1988; I 13: 979-84.
Moore DJ, Dreckow D, Robb TA, Davidson GP. Breath H1 and behavioural response in breast and formula fed infants with colic to modified lactose intake. J. Pediatr Child Health. 1991; 27: 1128.
Nadasdi M. Tolerance of a soy formula by infants and children. Clin Therap. 1992; 14(2): 236-241.
Neilsen Market ing Research. Sales trends of infant formulas. Chicago: A. C. Neilsen Co, 1991.
O 'Keefe ES. The relation of food to infantile eczema. Boston Med Surg J. 1920: 183: 569.
Paradise JL. Maternal and other factors in the aetiology of infantile colic. JAMA. 1966; 197: 191-9.
Parker SL, Krondl ~ Coleman P. Foods perceived by adults as causing adverse reactions. JADA. 1993; 93 (1) : 40-44.
Rautava P, Helenius H, Lehtonen L. Psychological predisposing factors for infantile colic. BMI. 1993; 307: 600-604.
Rubin SP, Prendegast M. Infantile colic: incidence and treatment in a Norfolk community. Child Care - Health and Dev. 1984; 10(4): 2 19- 226.
Sampson HA, Bemhisei-Broadbent J, Yang E, Scanlon S. Safety of casein hydrolysate formula in children with cow milk allergy. I Pediatr 1991; 118: 520-525.
Santosbam M, Foster S, Reid R et. al. Role of soy-based, lactose-free formula during treatment of acute diarrhea. Pediatrics. 1985; 76: 292.
Schmitz J, Digeon B, Chastang C, Dupouy D, Leroux B, Robillard P, Strobel S. Effects of brief early exposure to partially hydrolysed and whole cow milk proteins. J Pediatr. 1992; 121: S85-S89.
so
• • • II II Ill Ill lll r
Scimshaw NS, Murray ED. The milk consumption of various populations. Am J Clin Nutr. 1988; 48: 1086-1098.
Spock B. Etiological factors in hypertrophic pyloric stenosis and infantile colic. Psychosom Med. 1944; 6: 162- 165.
Stahlberg M. Infantile colic- OC{:urrence and risk factors. Eur J Pediatr. 1984; 143: 108-111. Talbot FB. Eczema in childhood. Med Clin North Am 1918; 1: 985.
Thomas OW, McGilligan K, Eisenberg LD, Lieberman HM, Rissman ED. Infantile colic and type of milk feeding. AJDC. 1987; 141: 451-453.
Weissbluth M, Christoffel KK, Davis T. Treatment of infantile colic with dicyclomine hydrochloride. J . Pediatrics. 1984; 104: 951.
Weizman Z, Alkrinawi S, Goldfarb D, Bitran C. Efficacy of herbal tea preparation in infantile colic. J Pediatr 1993; 122: 650-652.
Wessel MD, Cobb JC, Jackson EB, Harris GS, Detwiler AC. Parox-ysmal fussing in infancy, sometimes called "colic'' . Pediatrics. 1954. 14(5): 421.
White PJ. The relation between colic and eczema in early infancy. Am. J. Dis of Children. 1929; 38: 938 - 42.
Wolke D, Gray P, Meyer R. Excessive infant crying: a controlled study of mothers helping mothers. Pediatrics. 1994. 94(3): 322-332.
Woolridge MW, Fisher C. Colic, "overfeeding'', and symptoms of lactose malabsorption in the breast-fed baby: a possible artefact of feed management? The Lancet, 1988 August 13: 382-384.
Zeiger RS, Heller S, Mellon MH, et at. Effect of combined maternal and infant food allergen avoidance on development of atopy in early infancy: a randomized study. J Allergy Clin Immunol. 1989; 84: 72-89.
51
APPENDIX:
Figure I. Survey sent to health professionals.
(P.T.O)
SURVEY OF INFANT FEEDING PRACTICES
Tit is survey is being canied out by the Allergy Unit Royal Prince Alfred Hospital, Sydney, in order to identify current patterns of practice amongst health professionals giving advice on infant feedong on the Australian and New Zealand community.
We would be grateful if you could tnke n few minutes to fi ll out the quesuonnairc below ond return it in the enclosed reply-paid envelope (New Zealnnd p:uticipants will need to provide a stamp and we apologise for th is inconvenience). If the results nre 10 be representative of curren1 practice throughout the counuy it is unportant for as many individuals us possible to respond. The findings will be collated and pubhshed in Heinz.Sight. and eventually we hope tO be able to use the information to produce edue~tional literature for parents. community health workers and doctors.
The survey itSelf is anonymous, but 11 would be helpful if you could fltSt anS\•cr a few questions about yourself and your type of practice:
Age: 0 20-30 030-40 0 40-50 0 50-60 0 60t-
Sex: O Male 0 Female
Occupation:
Posteode:
Years of experience with infants: 0 <2yrs 0 2-5 yrs 0 5-10 yrs 0 > tOyrs
Approximately bow many babies do you see each week in each of the following oge ranges:
0-3 months D 3-6 months D 6· 12 months D 12-24 months D 24-36 months D
Now, please tum over the page. You will lind a number of questions relating to three common clinical problems for w~ch we would like to know your usual infant feeding recommendations:
The itritable, colicky baby • The baby with frequent loose stools • The baby with eczem~
Answer the questions as best you can to reOect your usual infant feeding recommendations in each situation. If you'd like to elaborate on your answers, feel free to write comments in 1he margins or ndd extra sheets.
For the irritable, colicky baby who is breast fed, under wha< circumstances would you recommend weaning onto an infant formula?
How often would this be necessary in your experience? (Mark your answer with an X on the scale below)
Never
0% 25% 50% 75%
Always
100%
U the baby is to be weaned, what would be your first choice of weaning fommla? ·
4. How often woulct you find little or no improvement. and need to recommend anOther fonnula?
Never Always
0% 25% 50% 75% 100%
What other fom1ulas would you suggest introducing and- how often is this necessary in your experience? (Lisl your preferences in order, and mark how often on tl1e scale.)
Fonnula How often?
Never
THE BABY WITH FREQUENT LOOSE STOOLS
Always
I. For the baby with frequent loose stools who is breast fed, under what circumstances would you recommend weaning onto an infant formula?
2. . How.often would this be necessary in your experience? (Mark your answer with an X on the scale below)
Never Always
0% 25% 50% 15% 100%
3.
4.
If the baby is to be weaned, what would be your ftrst choice of weaning fonnula?
How often would you find linJe or no improvement, and need to recommend another formula?
~- A~~s
0% 25% 50% 75% 100%
What other formulas would you suggest introducing and how often is this necessary in your experience? (List your preferences in order, and mark how often on the scale.)
Formula How often?
Never Always
THE BABY WITH ECZEMA
I .
2.
3.
4.
For the baby with eczema who is breast fed, under what Circumstances would you recommend weru~ing onto an infant formula?
How oflen would this be necessary in your experience? (Mark your answer with an X on the scale below)
Never
0% 25% 50% 75%
Always
100%
If the baby is to be weaned, what would be your fi rst cho ice o f weaning fonnula?
How often wo uld you lind little or no improvement, and need to recommend another formula?
Never Always
.0% 25% 50% 75% 100%
Please tum ~ver
What olher fonnulas would you suggest introducing and how often is this necessary in your experience? (List your preferences in order, and mark how often on lhc scale.)
Fonnula How often?
Never Always
MOTHER'S DIET
I .
2.
Have you ever found dlat a breast-feeding molher's diet can influence her baby's symptoms?
0 Yes
0 No 0 Don't know
If yes, how frequently do you lhink this occurs?
Never
0% 25% 50% 75'16
Which symptoms have you observed, and how often?
Never
Colic 0
Reflux 0
Diarrhoea 0
Eczema 0
Mucus 0
Wheezing 0
Other: 0
Orner: 0
Olher: 0
Always
100%
In your experience. which foods in lhe molhcr's diet are most often incriminated?
Foods: Most common symptoms
Always
• .. II)
COLIC: one or moreofthe following. • Colic. • Irritable, irritability, restless. • Difficult to settle, unsettled, unsettledness. • Crying, screaming, distressed, upset. • Abdominal pain. • Wind, flatulence, bloating. * Drawing up legs.
LOOSE STOOLS: one or more of the following. • Loose stools. • Frequent bowel motions/increase in bowel motions. • Diarrhoea. • Yellow stools, green stools, offensive stools, frothy stools.
1't • Scalded bottom, excoriated anus.
ECZEMA: one or more of the following. • Eczema. • Dry, scaly skin.
REFLUX: one or more of the following. * Reflux. * Vomiting.
WHEEZING: • Wheezing.
MUCUS: • Mucus.
OTHER: one or more of the following. * Drowsy, sleepy. • Wakeful, alert. • Hypotonic, hypertonic. • Difficulty feeding. • Hyperactivity, overactivity. * Poor sleeping. • Lactose intolerance symptoms. • Bloody stools. • Colitis.
• Poor weight gain, failure to thrive. • Ear and chest infection. • Allergic reaction. • Oedema. • Skin problems, skin eruptions,
pimples, facial spots, spots. • Rash. • 1-fwes .
Figure 2: Symptoms classified as colic, loose stools, eczema, reflux, wheezing, mucus, and other.
u
·~---------------------
•
• , •• -.. .. .. .. II Ill
Douglas Pbannaceutital• Au<!. Ltd:
Mead J ohnson Australia:
Sbaroe Laboratories Ptx Ltd:
Wveth Phannaceuticab :
Kariume Infant Formula.
KariL'l!le Follow-On Formula.
KariUIDC Soya Infant Fonnula.
Karitane SO)'ll Follow-On.
Kariume Goat Infant Fonnula.
Karitanc Goat Follow-On.
Enfalac.
Enfapro-6.
Enfamil
Enfalac (Redua:d Iron).
Enfalac (Ready To Usc).
0 -Lac.
Prosobec Powder.
Prosobec Redua:d lion Powder.
Prosobec Concentrated Liquid.
Prosobee (Ready To Use).
Nutramigen.
PregcstimiL
Digestclact.
Delact Infant
Neocate .
S26.
S26 Progress .
SMA.
lnfasoy .
Figure 3: Formulas on which infant fonnula consumption was based.
IU
• iii
•
~-· II
• • .. Ill ill ill
Table I: Cbar.lcteristics of the 35-1 respondents to lbe survey.
OIARACTERISTIC 0
GENDER:
Male 33
Female 315
Not Given 6
Excluded 9
AGE:
2~ 13
3~ 1U
40+ 149
~ 67
~ 10
Not Given 3
Excluded 9
COIJNfRY &STATE:
Ausualia 363
NT 2
NSW 54
VIC 152
Q 57
SA 23
WA 44
TAS 14
Not Given 8
E.xcluded 9
New Zealand 0
%
9.3
89.0
1.7
0.0
3.7
31.6
42.1
18.9
2.8
0.9
0.0
100.0
0.6
15.2
42.9
16.1
6.5
12A
4.0
2.3
0.0
0.0
IV
Ill Ill
•
•
Table 2: Occupation and e.<perience of the 354 respondents for the Slm'e)'.
CHARACIERISTIC n
OCCUPATION:
Dietitian 19
Doctor 22
Educator 0
Nurse 284
Paediatrician 2S
Nol Gjyen 4
Excluded 9
YEARS EXPERIENCE:
<2 10
2 < yeaJS < 5 36
5 <years < 10 70
> 10 233
Not Given s
Excluded 9
BABIES/WEEK:
0 - 3 months 4,937
3 - 6 months 3,773
6- 12 months 3,091
12 - 24 months 2,124
24 - 36 months 1,581
%
5.4
6 .2
0.0
80.2
7.1
1.1
0.0
2.8
10.2
19.8
65.8
1.4
0.0
31.8
24.3
20.0
13.7
10.2
v
•
•
Table 3: Percentage of the respondenas who wrote "Yrs" to mother's diet and "Yes'' to matemal diet