Questionnaires: Breastfeeding and Infant Feeding Practices

Infant Feeding Practices Study II and Its Year Six Follow-Up

A woman breastfeeding

The Infant Feeding Practices Study II followed women continuously from pregnancy throughout their infant’s first year of life. During pregnancy, each woman was mailed a Prenatal Questionnaire and a subsample of 1,500 women received the Diet History Questionnaire. These questionnaires were followed by a telephone Birth Screener interview around the expected date of delivery to determine whether the baby had been born.

Each mother and baby was followed with a Neonatal Questionnaire mailed 2 to 4 weeks after the baby’s birth. Then came a series of nine Postnatal Questionnaires mailed approximately monthly throughout the infant’s first year of life. When the infant was about 4 months old, another Diet History Questionnaire was sent to a subsample of 1,500 mothers to assess the mother’s diet. To the extent possible, the postnatal Diet History Questionnaire was sent to the same women who completed it prenatally.

A Demographic Questionnaire was routinely sent to consumer opinion panel members. This questionnaire asked for basic demographic data including age and sex of all household members, household size, race and Hispanic ethnicity, marital status, education, employment status, occupation, household income, and home ownership.

The Prenatal and Postpartum Diet History Questionnaires collected information from a subsample of mothers about their food consumption and intake of nutrients from foods and dietary supplements. Using identical questionnaires mailed near the end of pregnancy and about 4 months postpartum, this part of the study provided information on the mother’s consumption of certain fortified foods, foods of concern during pregnancy and lactation, alcohol intake, prenatal vitamin supplements, and herbal and botanical preparations sometimes used for conditions of pregnancy or breastfeeding. Until the IFPS II, little was known about the use of herbal products among pregnant and lactating women. The Non-pregnant/Non-postpartum Diet History Questionnaire was identical to the prenatal and postpartum versions. It was sent to a sample of 1,400 non-pregnant/non-postpartum women of child-bearing age for comparison purposes.

The Prenatal Questionnaire was sent when the woman was in the third trimester of pregnancy. It focused on factors associated with infant feeding choices, the baby’s family medical history, and the mother’s employment and social support system.

The Birth Screener consisted of a very short telephone interview with any adult household member to determine whether the infant had been born and to determine whether the family qualified to continue their participation in the study. If the family could not be reached by telephone, they were mailed a postcard asking them to dial into an Interactive Voice Response questionnaire. If they did not respond to the post card, they were mailed a copy of the Birth Screener questions along with the Neonatal Questionnaire around the time they would have received this questionnaire if the baby had been born on the due date. To qualify, women and their infants had to meet these criteria:

  • Healthy infant and mother
  • Full-term or near-term birth
  • Birth weight of at least 5 pounds
  • A single birth (no twins or multiple births)

The Neonatal Questionnaire was sent to the mother when her infant is approximately 3 weeks old. This questionnaire examined factors that commonly occur near the time of the birth and that affect infant feeding choices. It also asked about early feeding practices (including herbal intake by the infant), sources of information, sources of support, and any feeding-related treatment for jaundice.

  • Section A inquires about child care and characteristics including who cares for the child when not in school and where the childcare occurs, type of school and grade, provision of an individualized education program or any special developmental services, cognitive stimulation at home, and the Strengths and Limitations Questionnaire.
  • Section B documents information related to the child’s current health status and includes questions that document the measurement of the child’s weight and height. The mother was sent a tape measure and instructions on measuring the child’s height and was asked to report the measurement. She was also asked to weigh the child on a scale and report the weight. In addition, the mother was asked to report the last height and weight from a doctor’s office and the date of the measurements. Section B continues with questions about the mothers’ perceptions of her child’s weight, dental care, the child’s health, and the child’s use of herbal or botanical remedies. This section also has detailed questions about breathing difficulties and food allergy. Use of herbal or botanical remedies was included in this section on health rather than in the dietary intake section to measure use of such supplements as medicines rather than as beverages (e.g., herbal tea consumed as a beverage).
  • Section C asks about the child’s level of physical activity, screen time, and sleeping characteristics.
  • Section D begins with questions about exposure to pets and inhaled contaminants other than cigarette smoke, including air fresheners, scented candles, and pesticides. The remainder of the section is about the child’s eating patterns, dietary intake measured by a food frequency questionnaire, the food environment, such as the availability of healthful snacks, and parent control of the child’s diet and eating.
  • Section E is about the mother and family. It includes a family medical history, mother’s anthropometry, cigarette smoking by the mother and in the home, mother’s physical activity level, a depression scale for the mother, pregnancy and child feeding history, employment, insurance coverage for the child, and receipt of government benefits (including WIC participation for the 6-year-old and any children born after the 6-year-old).

The Postnatal Questionnaires consist of various combinations of 8 modules that were mailed to the mother approximately monthly from the time her infant is 2 months through 7 months of age, then 3 times (about every 7 weeks) until 12 months of age. Many of the modules include questions that are asked in some months but not others. View the timetable [PDF-43KB] for the administration of each topic. Explore the information below to view the questionnaire topics and questionnaires by month.

Module A: Infant Feeding and Health
Module A was sent with each Postnatal Questionnaire. This module contained one of the major measures of the study, the infant’s food frequency checklist. It also asked about dietary supplement and herbal intake by infants, details about breastfeeding and infant formula feeding, infant health and use of medicines, infant weight and length, stool characteristics, and feeding of commercial baby foods. In month 2 only, it included a measure of postpartum depression.The food frequency checklist enabled researchers to analyze patterns of breastfeeding exclusivity, in particular whether mothers occasionally gave formula to an infant who is otherwise exclusively breastfed. Patterns of feeding foods other than breast milk and formula indicated the extent to which mothers followed current infant feeding guidelines, such as those published by national professional organizations. Information on whether foods fed to infants are baby foods or not provided information about exposure of infants to foods marketed for older children and adults, including foods fortified at levels only appropriate for older age groups.Module B: Breastfeeding Cessation
Questions regarding breastfeeding cessation were included on each Postnatal Questionnaire, but they were answered only once, just after the mother had completely stopped breastfeeding. This module established the infant age when breastfeeding ceased and asked reasons for breastfeeding cessation and attitudes toward breastfeeding.Module C: Food Allergy
The food allergy segment asked whether the mother believed that the infant had a food allergy, details of the implicated food, and details of the infant’s symptoms, diagnosis, and treatment. Module C was sent at infant ages 4 months, 9 months, and 12 months.Module D: Breastfeeding, Pumping and Expressing Milk
Module D asked for details about breastfeeding, the mother’s sources of information, any maternal dietary change due to breastfeeding, her reasons for supplementing with formula or other foods, and details of her experience expressing breast milk manually or with a breast pump. Module D also included a measure of the mother’s embarrassment about breastfeeding and how she managed breastfeeding and work. This module was sent three times, at months 2, 5, and 7.Module E: Infant Formula
Module E asked for details about formula feeding, formula label use and understanding, sources of information, brand formula choice, brand formula changing, and food safety practices. Module E was sent 4 times, at months 2, 5, 7, and 9.Module F: Information Sources
Module F had questions that were not asked together, but rather were inserted among questions in the other modules as appropriate. A question about sources of information on herbal products was sent at months 3 and 10. Questions about information sources for breastfeeding were sent in month 2, and questions about information sources for general infant feeding were sent in months 4 and 10.Module G: Breastfeeding Awareness Campaign Evaluation
Module G included the direct measures of the mother’s awareness of the National Breastfeeding Awareness Campaign messages and whether she agreed with those messages. Like those questions presented in Module F, questions from Module G were not asked as a separate module but rather as questions incorporated at appropriate places in other modules. Questions from Module G were sent in months 3 and 7.

Module H: Sleeping Arrangements, Child Care, Employment, and Health
Module H asked about all topics other than feeding. These included sleeping arrangements and position; child care and child care support for breastfeeding; details of the mother’s employment and employer support for breastfeeding; how mothers managed to combine breastfeeding and work for pay; and the mother’s overall health, weight status, and tobacco use. Module H was sent in months 3, 6, 9, and 12. A question about exposure to sunlight was administered at infant age 9 months.

Module J: Other Information
Questions about WIC participation and any severe health problems the infants may have encountered were placed at the end of each Postnatal Questionnaire. The presence of severe health conditions disqualified infants from participating in the rest of the study. Certain questions from other modules that did not fit elsewhere were also included in Module J in the months those modules were administered.

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