Nursing, its duration and its outcomes for mother and child.
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126 to 150 of 480Substance use in pregnancy.
Objective: To improve awareness and knowledge of problematic substance use in pregnancy and to provide evidence-based recommendations for the management of this challenging clinical issue for all health care providers.
Options: This guideline reviews the use of screening tools, general approach to care, and recommendations for clinical management of problematic substance use in pregnancy.
Outcomes: Evidence-based recommendations for screening and management of problematic substance use during pregnancy and lactation.
Evidence: Medline, PubMed, CINAHL, and The Cochrane Library were searched for articles published from 1950 using the following key words: substance-related disorders, mass screening, pregnancy complications, pregnancy, prenatal care, cocaine, cannabis, methadone, opioid, tobacco, nicotine, solvents, hallucinogens, and amphetamines. Results were initially restricted to system…
matched on Breast Feeding (mesh), breastfeeding (text), Infant, Newborn (mesh)
Iodine supplementation for women during the preconception, pregnancy and postpartum period.
Background: Iodine is an essential nutrient required for the biosynthesis of thyroid hormones, which are responsible for regulating growth, development and metabolism. Iodine requirements increase substantially during pregnancy and breastfeeding. If requirements are not met during these periods, the production of thyroid hormones may decrease and be inadequate for maternal, fetal and infant needs. The provision of iodine supplements may help meet the increased iodine needs during pregnancy and the postpartum period and prevent or correct iodine deficiency and its consequences.
Objectives: To assess the benefits and harms of supplementation with iodine, alone or in combination with other vitamins and minerals, for women in the preconceptional, pregnancy or postpartum period on their and their children's outcomes.
Search methods: We searched Cochrane Pregnancy and Childbirth's Trials Regis…
matched on breastfeeding (text), Infant, Newborn (mesh), Postpartum Period (mesh)
Sucrose for analgesia in newborn infants undergoing painful procedures.
Background: Administration of oral sucrose with and without non-nutritive sucking is the most frequently studied non-pharmacological intervention for procedural pain relief in neonates.
Objectives: To determine the efficacy, effect of dose, method of administration and safety of sucrose for relieving procedural pain in neonates as assessed by validated composite pain scores, physiological pain indicators (heart rate, respiratory rate, saturation of peripheral oxygen in the blood, transcutaneous oxygen and carbon dioxide (gas exchange measured across the skin - TcpO2, TcpCO2), near infrared spectroscopy (NIRS), electroencephalogram (EEG), or behavioural pain indicators (cry duration, proportion of time crying, proportion of time facial actions (e.g. grimace) are present), or a combination of these and long-term neurodevelopmental outcomes.
Search methods: We used the standard methods of t…
matched on breastfeeding (text), Infant, Newborn (mesh), Infant, Premature (mesh)
What is kangaroo mother care? Systematic review of the literature.
Background: Kangaroo mother care (KMC), often defined as skin-to-skin contact between a mother and her newborn, frequent or exclusive breastfeeding, and early discharge from the hospital has been effective in reducing the risk of mortality among preterm and low birth weight infants. Research studies and program implementation of KMC have used various definitions.
Objectives: To describe the current definitions of KMC in various settings, analyze the presence or absence of KMC components in each definition, and present a core definition of KMC based on common components that are present in KMC literature.
Methods: We conducted a systematic review and searched PubMed, Embase, Scopus, Web of Science, and the World Health Organization Regional Databases for studies with key words "kangaroo mother care", "kangaroo care" or "skin to skin care" from 1 January 1960 to 24 April 2014. Two independ…
matched on exclusive breastfeeding (text), breastfeeding (text), Infant, Newborn (mesh)
NICU infant health severity and family outcomes: a systematic review of assessments and findings in psychosocial research.
Many infants (7-15%) spend time in the neonatal intensive care unit (NICU) and continue to experience medical issues after discharge. Family psychological responses range widely depending on burden of care, access to resources, and parental characteristics. The current systematic review examined how infant health severity is assessed and related to family psychological (e.g., mental health) and social (e.g., parent-infant attachment) outcomes. Seventy articles were deemed relevant. Infant health was operationalized in several ways including validated assessments, indices of infant health (e.g., diagnosis, length of stay), or novel measures. Parents of infants with increased medical complications reported greater family impact, increased stress, and more intrusive parenting style. A validated assessment of infant health that utilizes parent report is warranted to allow for more accessible…
matched on Intensive Care Units, Neonatal (mesh), Infant, Newborn (mesh), Infant, Premature (mesh)
Pineda RG (2011)MEDLINE-indexed journal, not yet read by usBreastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine72 citations Predictors of breastfeeding and breastmilk feeding among very low birth weight infants.
Objective: This study investigated associations between maternal and infant factors and breastfeeding practices in infants born <30 weeks gestation in the neonatal intensive care unit (NICU).
Study design: This study was a retrospective cohort. Mother and infant characteristics were investigated for associations with breastfeeding outcomes using multivariate logistic regression.
Results: Seventy-eight percent of infants initiated breastmilk feedings, 48% of those continued to have breastmilk at discharge, and 52% were breastfed in the hospital. The average duration of breastmilk feedings was 43 days. Mothers who were married and had a multiple-infant birth were more likely to initiate breastmilk feeds, African American mothers and younger mothers had less success with maintaining breastmilk feeds until hospital discharge, and African American mothers and mothers of lower socioeconomic st…
matched on Breast Feeding (mesh), Milk, Human (mesh), Intensive Care Units, Neonatal (mesh), breastfeeding (text), Infant, Newborn (mesh)
Postpartum recovery: what does it take to get back to a baseline?
Purpose of review: Limited guidance exists regarding how to assess postpartum recovery. In this article, we discuss various aspects of inpatient and outpatient postpartum recovery.
Recent findings: The postpartum period for many women includes sleep deprivation, maternal-neonatal bonding, breastfeeding, and integrating a new life into the family unit. Factors which impact inpatient quality of recovery include pain, nausea or vomiting, dizziness, shivering, comfort, mobilization, ability to hold and feed the baby, personal hygiene maintenance, and feeling in control. Outpatient recovery domains include psychosocial distress, surgical/medical factors, feeding and breast health, psychosocial support, pain, physical function, sleep, motherhood experience, infant health, fatigue, appearance / cosmetic factors, sexual function, and cognition. Postpartum recovery is likely to take longer than s…
matched on Breast Feeding (mesh), breastfeeding (text), Infant, Newborn (mesh), Postpartum Period (mesh)
Racism, Bias, and Discrimination as Modifiable Barriers to Breastfeeding for African American Women: A Scoping Review of the Literature.
Introduction: Although breastfeeding has been shown to improve health outcomes for infants, African American women initiate and continue breastfeeding at lower rates than women from other racial groups. This scoping review was conducted to assess the effect racism, bias, and discrimination have on breastfeeding care, support, and outcomes for African American women.
Methods: A scoping review was performed of the literature published between January 2010 through December 2019 using databases MEDLINE via PubMed, CINAHL, Cochrane Library, PsycINFO, and Sociological Abstracts. Studies that examined racism, bias, or discrimination with breastfeeding as an outcome were included. After a review of titles and abstracts of the articles using exclusion and inclusion criteria, 5 full-text articles were included in the scoping review.
Results: The qualitative and quantitative studies reviewed provid…
matched on Breast Feeding (mesh), breastfeeding (text), Postnatal Care (mesh), Postpartum Period (mesh)
Leroy V, Sakarovitch C, Viho I, Becquet R, Ekouevi DK, Bequet L, Rouet F, Dabis F, Timite-Konan M, ANRS 1201/1202 Ditrame Plus Study Group (2007)MEDLINE-indexed journal, not yet read by usJournal of acquired immune deficiency syndromes (1999)21 citations Acceptability of formula-feeding to prevent HIV postnatal transmission, Abidjan, Côte d'Ivoire: ANRS 1201/1202 Ditrame Plus Study.
Objective: To describe the maternal acceptability of formula-feeding proposed to reduce postnatal HIV transmission in Abidjan, Côte d'Ivoire.
Methods: Each consenting HIV-infected pregnant women, age > or =18 years, who received a perinatal antiretroviral prophylaxis was eligible. Two hierarchical infant-feeding options were proposed antenatally: exclusive formula-feeding or short-term exclusive breast-feeding. Formula-feeding was provided free up to age 9 months. Determinants of acceptability were analyzed using a logistic regression. Formula-feeding failure was defined as having breast-fed one's child at least once.
Results: Between March 2001 and March 2003, 580 women delivered: 97% expressed their infant-feeding choice before delivery; 53% chose formula-feeding. Significant prenatal determinants for refusing formula-feeding were: living with her partner, being Muslim, having a low ed…
matched on Breast Feeding (mesh), Milk, Human (mesh), Weaning (mesh), Infant, Newborn (mesh)
Maternal posttraumatic stress disorder during the perinatal period and child outcomes: A systematic review.
Background: Approximately 3.3% of women in pregnancy have posttraumatic stress disorder (PTSD) and 4% of women postpartum PTSD. The impact of maternal PTSD during the perinatal period (from conception until one year postpartum) on child outcomes has not been systematically examined.
Method: A systematic review was conducted to synthesize and critically evaluate quantitative research investigating the association between perinatal PTSD and child outcomes. Databases EMBASE, BNI, Medline, PsycInfo and CINAHL were searched using specific inclusion and exclusion criteria.
Results: 26 papers reporting 21 studies were identified that examined associations between perinatal PTSD and postpartum birth outcomes, child development, and mother-infant relationship. Studies reviewed were heterogeneous, with poor-to-medium scores of methodological quality. Results showed that maternal postpartum PTSD is…
matched on breastfeeding (text), Infant, Newborn (mesh), Postpartum Period (mesh)
Informal Milk Sharing for the Hospitalized at-Risk Infant in the Ultra-Orthodox-Haredi Jewish Community in the United States.
The process of human milk donation and sharing for the promotion of infant health is a phenomenon of interest as it directly affects children's health and well-being. Although its prevalence is currently unknown, informal sharing of human milk is occurring across the United States. The U.S. Food and Drug Administration recommends against informal sharing of human milk. However, the Ultra-Orthodox (Haredi) Orthodox Jewish population, who strictly observes Jewish laws and often consults with rabbis before making medical decisions, is known to donate and obtain milk through informal sharing. The objective of this study was to explore the lived experience of informal donation from the perspective of Ultra-Orthodox mothers from the Northeastern region of the United States who engaged in milk sharing to support hospitalized at-risk infants. Women were interviewed by an Orthodox Jewish member o…
matched on Breast Feeding (mesh), Milk, Human (mesh), breastfeeding (text), human milk (text), Infant, Newborn (mesh)
O'Brien K, Robson K, Bracht M, Cruz M, Lui K, Alvaro R, da Silva O, Monterrosa L, Narvey M, Ng E, Soraisham A, Ye XY, Mirea L, Tarnow-Mordi W, Lee SK, FICare Study Group and FICare Parent Advisory Board (2018)randomised controlled trialMEDLINE-indexed journal, not yet read by usThe Lancet. Child & adolescent health374 citations Effectiveness of Family Integrated Care in neonatal intensive care units on infant and parent outcomes: a multicentre, multinational, cluster-randomised controlled trial.
Background: Despite evidence suggesting that parent involvement was beneficial for infant and parent outcomes, the Family Integrated Care (FICare) programme was one of the first pragmatic approaches to enable parents to become primary caregivers in the neonatal intensive care unit (NICU). We aimed to analyse the effect of FICare on infant and parent outcomes, safety, and resource use.
Methods: In this multicentre, cluster-randomised controlled trial, we stratified 26 tertiary NICUs from Canada, Australia, and New Zealand by country and size, and assigned them, using a computer-generated random allocation sequence, to provide FICare or standard NICU care. Eligible infants were born at 33 weeks' gestation or earlier, and had no or low-level respiratory support; parents gave written informed consent for enrolment. To be eligible, parents in the FICare group had to commit to be present for a…
matched on Intensive Care Units, Neonatal (mesh), breastfeeding (text), Infant, Newborn (mesh)
Kumar V, Mohanty S, Kumar A, Misra RP, Santosham M, Awasthi S, Baqui AH, Singh P, Singh V, Ahuja RC, Singh JV, Malik GK, Ahmed S, Black RE, Bhandari M, Darmstadt GL, Saksham Study Group (2008)randomised controlled trialMEDLINE-indexed journal, not yet read by usLancet (London, England)335 citations Effect of community-based behaviour change management on neonatal mortality in Shivgarh, Uttar Pradesh, India: a cluster-randomised controlled trial.
Background: In rural India, most births take place in the home, where high-risk care practices are common. We developed an intervention of behaviour change management, with a focus on prevention of hypothermia, aimed at modifying practices and reducing neonatal mortality.
Methods: We did a cluster-randomised controlled efficacy trial in Shivgarh, a rural area in Uttar Pradesh. 39 village administrative units (population 104,123) were allocated to one of three groups: a control group, which received the usual services of governmental and non-governmental organisations in the area; an intervention group, which received a preventive package of interventions for essential newborn care (birth preparedness, clean delivery and cord care, thermal care [including skin-to-skin care], breastfeeding promotion, and danger sign recognition); or another intervention group, which received the package of…
matched on Infant Care (mesh), breastfeeding (text), Infant, Newborn (mesh)
Early intervention of multiple home visits to prevent childhood obesity in a disadvantaged population: a home-based randomised controlled trial (Healthy Beginnings Trial).
Background: Studies have shown that a proportion of children as young as two years are already overweight. This indicates that obesity prevention programs that commence as early as possible and are family-focused are needed. This Healthy Beginnings Trial aims to determine the efficacy of a community-based randomized controlled trial (RCT) of a home visiting intervention in preventing the early onset of childhood overweight and obesity. The intervention will be conducted over the first two years of life to increase healthy feeding behaviours and physical activity, decrease physical inactivity, enhance parent-child interaction, and hence reduce overweight and obesity among children at 2 and 5 years of age in the most socially and economically disadvantaged areas of Sydney, Australia.
Methods/design: This RCT will be conducted with a consecutive sample of 782 first time mothers with their n…
matched on Infant Care (mesh), breastfeeding (text), Infant, Newborn (mesh)
Barlow A, Varipatis-Baker E, Speakman K, Ginsburg G, Friberg I, Goklish N, Cowboy B, Fields P, Hastings R, Pan W, Reid R, Santosham M, Walkup J (2006)randomised controlled trialMEDLINE-indexed journal, not yet read by usArchives of pediatrics & adolescent medicine50 citations Home-visiting intervention to improve child care among American Indian adolescent mothers: a randomized trial.
Objective: To assess the impact of a paraprofessional-delivered home-visiting intervention to promote child care knowledge, skills, and involvement among pregnant American Indian adolescents.
Design: Randomized controlled trial comparing a family-strengthening intervention with a breastfeeding education program.
Setting: One Apache and 3 Navajo communities.
Participants: Fifty-three pregnant American Indian adolescents were randomly assigned to intervention (n = 28) or control (n = 25) groups. Follow-up data were available for 19 intervention and 22 control participants. Intervention Paraprofessionals delivered 41 prenatal and infant care lessons in participants' homes from 28 weeks' gestation to 6 months post partum.
Main outcome measures: Child care knowledge, skills, and involvement.
Results: Mothers in the intervention compared with the control group had significantly higher parent k…
matched on Infant Care (mesh), breastfeeding (text), Infant, Newborn (mesh)
Dietary Inflammatory Potential during Pregnancy Is Associated with Lower Fetal Growth and Breastfeeding Failure: Results from Project Viva.
Background: Inflammation during pregnancy has been linked to adverse maternal and infant outcomes. There is limited information available on the contribution of maternal diet to systemic inflammation and pregnancy health.
Objective: The objective of this study was to examine associations of maternal prenatal dietary inflammatory index (DII), a composite measure of the inflammatory potential of diet, with markers of maternal systemic inflammation and pregnancy outcomes.
Methods: We studied 1808 mother-child pairs from Project Viva, a pre-birth cohort study in Massachusetts. We calculated the DII from first- and second-trimester food-frequency questionnaires by standardizing the dietary intakes of participants to global means, which were multiplied by the inflammatory effect score and summed. We examined associations of DII with maternal plasma C-reactive protein and white blood cell count…
matched on Breast Feeding (mesh), breastfeeding (text)
Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, Kalayjian LA, Kanner A, Liporace JD, Pennell PB, Privitera M, Loring DW, Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) Study Group (2014)cohort or longitudinalMEDLINE-indexed journal, not yet read by usJAMA pediatrics123 citations Breastfeeding in children of women taking antiepileptic drugs: cognitive outcomes at age 6 years.
Importance: Breastfeeding is known to have beneficial effects, but concern exists that breastfeeding during maternal antiepileptic drug (AED) therapy may be harmful. We previously noted no adverse effects of breastfeeding associated with AED use on IQ at age 3 years, but IQ at age 6 years is more predictive of school performance and adult abilities.
Objectives: To examine the effects of AED exposure via breastfeeding on cognitive functions at age 6 years.
Design, setting, and participants: Prospective observational multicenter study of long-term neurodevelopmental effects of AED use. Pregnant women with epilepsy receiving monotherapy (ie, carbamazepine, lamotrigine, phenytoin, or valproate) were enrolled from October 14, 1999, through April 14, 2004, in the United States and the United Kingdom. At age 6 years, 181 children were assessed for whom we had both breastfeeding and IQ data. All…
matched on Breast Feeding (mesh), breastfeeding (text)
Effectiveness of a modified Mother-Infant Transaction Program on outcomes for preterm infants from 3 to 24 months of age.
Mothers of hospitalised preterm infants were randomised into an intervention or control condition. Intervention mothers received a modified Mother-Infant Transaction Program over seven sessions prior to infant discharge and two sessions over the next 3 months. Infant temperament, mother-infant interaction and parenting stress were assessed at 3 and 6 months and infant development was measured by parental report at 24 months. Intervention compared with control dyads showed enhanced mother-infant interactions, infants were temperamentally more "approaching" and "easier", had fewer regulatory problems (colic, sleep, excessive crying), and had more developed communication skills, while mothers were less stressed by their infant at 3 months. These early gains in the development of preterm infants and in the relationship with and adjustment of their mothers, may explain the process by which in…
matched on Infant Care (mesh), Infant, Newborn (mesh), Infant, Premature (mesh)
Improving the outcome of infants born at <30 weeks' gestation--a randomized controlled trial of preventative care at home.
Background: Early developmental interventions to prevent the high rate of neurodevelopmental problems in very preterm children, including cognitive, motor and behavioral impairments, are urgently needed. These interventions should be multi-faceted and include modules for caregivers given their high rates of mental health problems.
Methods/design: We have designed a randomized controlled trial to assess the effectiveness of a preventative care program delivered at home over the first 12 months of life for infants born very preterm (<30 weeks of gestational age) and their families, compared with standard medical follow-up. The aim of the program, delivered over nine sessions by a team comprising a physiotherapist and psychologist, is to improve infant development (cognitive, motor and language), behavioral regulation, caregiver-child interactions and caregiver mental health at 24 months' c…
matched on Infant Care (mesh), Infant, Newborn (mesh), Infant, Premature (mesh)
Sleeping position and electrocortical activity in low birthweight infants.
Objective: To evaluate the effects of prone and supine sleeping positions on electrocortical activity during active (AS) and quiet (QS) sleep in low birthweight infants.
Design: Randomised/crossover study.
Setting: Infant Physiology Laboratory at Children's Hospital of New York.
Patients: Sixty three healthy, growing, low birthweight (birth weight 795-1600 g) infants, 26-37 weeks gestational age.
Interventions: Six hour continuous two channel electrocortical recordings, together with minute by minute behavioural state assignment, were performed. The infants were randomly assigned to prone or supine position during the first three hours, and positions were reversed during the second three hours.
Outcome measures and results: Fast Fourier transforms of electroencephalograms (EEGs) were performed each minute and the total EEG power (TP), spectral edge frequency (SEF), absolute (AP) and rela…
matched on Infant Care (mesh), Infant, Newborn (mesh), Infant, Premature (mesh)
Cultural differences in child delivery: comparisons between Jewish and Arab women in Israel.
Objective: To compare Jewish and Arab women characteristics regarding pregnancy follow-up, compliance to a health regime and behavioural expressions during labour, delivery and the post-partum period.
Design: The participants answered a 45-item questionnaire designed for the current research.
Setting: The first three post-partum days in the delivery ward at one of the biggest hospitals in Israel.
Participants: A total of 126 Jewish and Arab-Muslim parturients.
Results: Significant differences were found (P < 0.01) concerning pregnancy follow-up attendance and participation in a prenatal course, which were lower among Arab women. Several differences were found regarding delivery room attendance, type and number of companions, and behavioural expressions of pain, which were demonstrated more among Arab women. Epidural anaesthesia was highly prevalent among Jewish women, in comparison with …
matched on Breast Feeding (mesh), Postpartum Period (mesh)
[unknown] (2023)guidelineMEDLINE-indexed journal, not yet read by usObstetrics and gynecology134 citations Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum: ACOG Clinical Practice Guideline No. 5.
Purpose: To assess the evidence regarding safety and efficacy of psychiatric medications to treat mental health conditions during pregnancy and lactation. The conditions reviewed include depression, anxiety and anxiety-related disorders, bipolar disorder, and acute psychosis. For information on screening and diagnosis, refer to American College of Obstetricians and Gynecologists (ACOG) Clinical Practice Guideline Number 4, "Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum" (1).
Target population: Pregnant or postpartum individuals with mental health conditions with onset that may have predated the perinatal period or may have occurred for the first time in pregnancy or the first year postpartum or may have been exacerbated in that time.
Methods: This guideline was developed using an a priori protocol in conjunction with a writing team consisting of one …
matched on Breast Feeding (mesh), Lactation (mesh)
Effect of exclusive breastfeeding on selected adverse health and nutritional outcomes: a nationally representative study.
Background: Despite growing evidence in support of exclusive breastfeeding (EBF) among infants in the first 6 months of birth, the debate over the optimal duration of EBF continues. This study examines the effect of termination of EBF during the first 2, 4 and 6 months of birth on a set of adverse health and nutritional outcomes of infants.
Methods: Three waves of Bangladesh Demographic and Health Survey data were analysed using multivariate regression. The adverse health outcomes were: an episode of diarrhea, fever or acute respiratory infection (ARI) during the 2 weeks prior to the survey. Nutritional outcomes were assessed by stunting (height-for-age), wasting (weight-for-height) and underweight (weight-for-age). Population attributable fraction was calculated to estimate percentages of these six outcomes that could have been prevented by supplying EBF.
Results: Fifty-six percent of i…
matched on Breast Feeding (mesh), Infant Nutritional Physiological Phenomena (mesh), exclusive breastfeeding (text), breastfeeding (text), Infant, Newborn (mesh)
Characteristics of breastfeeding practices among US mothers.
Objectives: Although much has been published about breastfeeding rates, little is known about how breastfeeding is practiced in the United States. We describe the distributions and characteristics of practices related to common advice about breastfeeding during the infant's first year of life.
Participants and methods: Participants in the 2005-2007 Infant Feeding Practices Study II received monthly questionnaires during their infants' first year of life. Among breastfeeding respondents, we investigated patterns and trends in types of breastfeeding (supplementing with formula or not, and at the breast or not) and maternal report of infant feeding behaviors corresponding to common breastfeeding advice on frequency, duration, and intervals of feedings.
Results: More than half of the breastfeeding mothers fed their infants nothing other than breast milk until 4 months of age. Formula supplem…
matched on Breast Feeding (mesh), Infant Nutritional Physiological Phenomena (mesh), exclusive breastfeeding (text), breastfeeding (text), Infant, Newborn (mesh)
Tomori C (2022)reviewMEDLINE-indexed journal, not yet read by usBest practice & research. Clinical obstetrics & gynaecology47 citations Overcoming barriers to breastfeeding.
Breastfeeding is the evolved human infant feeding norm, practiced historically and across cultures. Over the past 200 years, breastfeeding practices have eroded, reaching a nadir in the middle of the 20th century. Mobilization from grassroots social movements, with support from public health and medicine, has yielded a substantial rise in overall breastfeeding prevalence. However, timely initiation, exclusive breastfeeding, and duration of breastfeeding still lag behind global targets. Inadequate breastfeeding leads to substantial morbidity and approximately 600,000 child deaths and an additional 100,000 maternal deaths annually. Most women and pregnant people are physiologically able and desire to breastfeed, however, they face substantial barriers. Effective interventions address health systems, workplace policies, and engage communities and families. However, substantial work remains …
matched on Breast Feeding (mesh), exclusive breastfeeding (text), breastfeeding (text)