Jane Anne Scott

Breastfeeding is the best way to feed an infant with short- and long-term health benefits of breastfeeding for both mothers and their infants. This chapter introduces current recommendations for breastfeeding and the evidence that supports these recommendations. The chapter describes the physiology of lactation and the unique nutrition and immunoprotective properties of breast milk. It also considers breastfeeding from the mother’s perspective, identifies nutrient requirements for lactation, and discusses the impact of maternal diet on breast milk composition. This chapter describes some of the common problems experienced by lactating women and presents strategies for supporting and encouraging women to breastfeed.

While breastfeeding is strongly recommended for infant health, uncertainty remains regarding its independent association with early childhood caries after accounting for sugar exposure. Objective: This study aimed to evaluate the controlled direct effect of breastfeeding on dental caries. Methods: Data were drawn from two population-based birth cohort studies: the 2015 Pelotas Birth Cohort Study (Brazil) and the SMILE Study (Australia). The exposure was any breastfeeding at 3, 6, and 12 months, with sugar consumption at 12 and 24 months as the mediator. The outcome was dental caries at ages 4/5, assessed as early childhood caries (ECC), severe ECC, any disease experience, or any decayed teeth. Marginal Structural Models with inverse probability of treatment weight were used to estimate the controlled direct effect of breastfeeding on dental caries, accounting for sociodemographic confounders and sugar consumption. Results: A total of 751 Australian and 3545 Brazilian children were included in at least one sub-analysis. Findings indicate a contextual difference: in Australia, breastfeeding had no effect on dental caries after considering sugar consumption as mediator, whereas in Brazil, children not breastfed had a lower risk of dental caries. For instance, adjusted Brazilian estimates showed a reduced relative risk ranging from 0.63 (95% CI 0.55; 0.72) for ECC to 0.43 (95% CI 0.34; 0.55) for severe ECC. Conclusions: The association between breastfeeding and dental caries appears to vary across socio-environmental contexts. In settings with high caries burden, prolonged breastfeeding may increase caries risk independently of sugar consumption; however, breastfeeding remains strongly recommended given its substantial overall health benefits. These findings highlight the importance of integrating early oral health guidance such as oral health education into breastfeeding support programs.

Issue Addressed: During the coronavirus disease 2019 (COVID‐19) pandemic, the infodemic has been highly visible. Vaccine‐related advice and evidence‐based guidelines for breastfeeding women have lagged, and, at times have been contradictory and confusing. Breastfeeding is an important public health issue with long‐lasting health benefits for infants and mothers. This online social listening study aimed to understand breastfeeding‐related narratives on social media during the early stages of the Australian COVID‐19 vaccine roll‐out.Methods: Public content about breastfeeding and COVID‐19 vaccines from Facebook pages with Australian‐based administrators were accessed via the CrowdTangle platform. All related content posted between 1 December 2020–31 December 2021 was included. Content (n = 29 567) was coded to an adapted vaccine narrative typology, and emergent themes were inductively identified.Results: Most posts were promoting, sharing or discussing reliable information. However, the comments responding to these posts varied more widely. Several consistent questions, concerns, and information voids were evident, and misinformation and conflicting information contributed to confusion and challenges with decision‐making.Conclusions: These findings highlight the complexities associated with decision‐making. Pregnant and breastfeeding women continue to be a priority group for vaccination, yet there were gaps in data, evidence and information. Incorporating social listening and infodemic management into public health work is important.So What?: Information voids, when identified early, can help inform public health messaging. Increasing social listening and infodemic training and skills in the health promotion workforce can help build future capacity and give insight into optimising public health communication and addressing misinformation.

Reducing free sugars intake is important for the prevention of dental caries and obesity in children. The study aimed to determine the amount and sources of free sugars known to contribute to dental caries, and identify sociodemographic determinants of intake by children aged 5 years in Australia. Cross‐sectional analysis of dietary data from a cohort study, collected using a customized food frequency questionnaire were used to calculate free sugars intake as grams/day and percentage contribution to Estimated Energy Requirement (EER). The percent contribution of food sources to free sugars intake was derived. Sociodemographic determinants of achieving intakes within WHO thresholds (i.e., <5% and <10% Energy were explored with multinomial logistic regression. Complete data were available for 641 children (347 boys, 294 girls). Median (IQR) free sugars intake (g/day) was 31.6 (21.3–47.6) in boys and 28.1 (19.6–47.9) in girls. The median (IQR) percentage contribution to EER was 7.9 (5.4–12.7); 21% and 42% of children had intakes <5% EER and between 5% and <10%, respectively. The main sources of free sugars were: (1) Cakes, Biscuits and Cereal Bars; (2) Sweetened Milk Products (predominantly yoghurts) and (3) Desserts. Maternal university education, single‐parent household, and maternal place of birth being Australia or New Zealand were associated with free sugars intake <5% EER. In conclusion, less than a quarter of 5‐year‐old children in the SMILE cohort achieved the WHO recommendations to limit free sugars to <5% EER. Strategies to lower free sugars intake could target priority populations such migrants, populations with lower levels of education or health literacy and identify areas for intervention in the wider food environments that children are exposed to.

Foods and beverages high in free sugars can displace healthier choices and increase the risk of weight gain, dental caries, and noncommunicable diseases. Little is known about the intake of free sugars across early childhood. This study aimed to examine the longitudinal intake from 1 to 5 years of free sugars and identify the independent maternal and child-related predictors of intake in a cohort of Australian children participating in the Study of Mothers’ and Infants’ Life Events Affecting Oral Health (SMILE). Free sugars intake (FSI) was previously estimated at 1, 2, and 5 years of age, and three distinct FSI trajectories were determined using group-based trajectory modelling analysis. This study utilized multinomial logistic regression to identify the maternal and child-related predictors of the trajectories. The risk of following the ‘high and increasing’ trajectory of FSI compared to the ‘low and fast increasing’ trajectory was inversely associated with socio-economic disadvantage (aRRR 0.83; 95% CI 0.75–0.92; p < 0.001), lower for females (aRRR 0.56; 95% CI 0.32–0.98; p = 0.042), and higher in children with two or more older siblings at birth (aRRR 2.32; 95% CI 0.99–5.42; p = 0.052). Differences in trajectories of FSI were evident from an early age and a high trajectory of FSI was associated primarily with socio-economic disadvantage, providing another example of diet quality following a social gradient.

Objective:To develop and internally validate a Free Sugars Screener (FSS) for Australian children aged 2 and 5 years.Design:Using data collected from a 99-item (2-year-olds) and 98-item (5-year-olds) Food Frequency Questionnaire in the Study of Mother’s and Infant’s Life Events affecting oral health (SMILE-FFQ), a regression-based prediction modelling approach was employed to identify a subset of items that accurately estimate total free sugars intake (FSI). The predictors were grams of free sugars (FSg) for individual items in the SMILE-FFQ and child’s age and sex. The outcome variable was total FSI per person. To internally validate the SMILE-FSS items, the estimated FSg was converted to percent energy from free sugars (%EFS) for comparison to the WHO free sugars guideline categories (<5%, 5-<10%, ≥10%EFS) using cross-classification analysis.Setting:Australia.Participants:858 and 652 2- and 5-year-old children, respectively, with complete dietary (<5% missing) and sociodemographic data.Results:22- and 26-items were important in predicting FSI at 2 and 5 years, respectively. Items were similar between ages with more discretionary beverage items (e.g., sugar-sweetened beverages) at 5 years. %EFS was overestimated by 4.4% and 2.6%. Most children (75% and 82%) were categorised into the same WHO free sugars category with most (87% and 95%) correctly identified as having <10%EFS in line with the WHO recommendation.Conclusions:The SMILE-FSS has good internal validity and can be used in research and practice to estimate young Australian children’s free sugars intake and compare to the WHO free sugars guidelines to identify those ‘at risk’.

Issue Addressed: Lifelong eating behaviours are established in childhood. Improving parents' food literacy skills is essential, as parents play a fundamental role in establishing their children's healthy eating behaviours and preferences for nutritious food. This paper describes the development and evaluation of an innovative program that combines food literacy with positive parent feeding practices, targeting parents in disadvantaged areas of Western Australia.Methods: The Food Sensations® for Parents five‐week program was delivered to participants from community‐based parenting organisations during 2020 and 2021. Formative research and a pre‐post evaluation design were adopted.Results: Pre‐ and post‐evaluation data were collected from 224 participants (96% female). There was a statistically significant improvement in the mean score for 13 food literacy behaviours, 10 positive parenting feeding practices and a mean increase in parents' daily vegetable intake of 1/3 serve. Participants reported significantly greater net improvements in food literacy behaviours than feeding practices, the largest being the Use a nutrition information panel to make food choices (33.1%). Multivariate logistic regression analyses found English as a first language, being older than 35, and from a higher Socio‐Economic Index for Areas resulted in a higher likelihood of positive changes in behaviours and practices.Conclusions: The findings indicate that the program is effective in improving the frequency of use of food literacy behaviours, positive parenting feeding practices and increasing vegetable consumption.So What?: Analysing improvements in food literacy behaviours and feeding practices provides clarity on what change can be expected with a five‐week parent program.

Issue addressed: The COVID‐19 pandemic has seen evidence and advice evolve quickly. Since the start of the pandemic there has been confusion and concern about breastfeeding and COVID‐19, and advice for this group has at times been contradictory. The volume of information on social media has exacerbated this. This study aimed to understand breastfeeding‐related COVID‐19 information sharing on social media during the global and Australian vaccine roll‐out.Methods: The CrowdTangle platform was used to source data from December 2020 to December 2021. Posts were categorised to intent and source and mapped to a timeline of pandemic‐related events and announcements. Descriptive analysis was used to understand data distribution patterns and qualitative analysis for post‐intent.Results: A total of 945 posts were included. Post‐interactions ranged from 0 to 6500. Vaccine‐related posts were the highest in number and increased over time. Non‐profit organisations shared the highest number of posts (n = 241), but interactions were highest with personal and government accounts. Peaks in posts and interactions mapped to key pandemic‐related announcements and events.Conclusion: These results describe the breastfeeding and COVID‐19 related content shared on Facebook over 13 months, and the associated interactions. Breastfeeding is an important public health issue and breastfeeding women have experienced conflicting and confusing breastfeeding‐related information during the COVID‐19 pandemic. Better understanding of social media usage, and the monitoring of changes in usage, as an emergency unfolds, can help target communications. This article adds to the evidence in understanding user reactions to COVID‐19 related breastfeeding information on social media.So what?: Social listening is an important part of health communication and infodemic management. Understanding how users react to and engage with COVID‐19 related breastfeeding information on social media can help to understand how the general public perceives and responds to health advice and other information being shared.