RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTSs
1. 1.
NAME AND ADDRESS
Ms. JINUMOL JOSEPH
OF THE CANDIDATE
1ST YEAR MSc NURSING
KNN COLLEGE OF NURSING
YELAHANKA, BANGALORE
NAME
2.
2
OF
THE KNN COLLEGE OF NURSING,
INSTITUTION
CA 23/B, A SECTOR, SATELITETOWN,
YELAHANKA, BANGALORE-64
COURSE OF THE STUDY
3.
3
AND THE SUBJECT
1ST YEAR M.SC (NURSING)
PAEDIATRIC NURSING
DATE OF ADMISSION
TO THE STUDY
4.
5.
28- 06-2012
4
RELATIONHIP
5
TITLE OF THE STUDY
BREAST
BETWEEN
FEEDING
SELECTED
PRACTICES
AND
SELECTED DEVELOPMENTAL ASPECTS OF
SCHOOL GOING CHILDREN
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“Mother’s milk, time-tested for millions of years, is the best nutrient for babies because it is
nature’s perfect food”
Motherhood is a beautiful and joyous experience to a woman. The health of the mother during
pregnancy is important to give birth to a healthy baby. The best and most precious gift a mother can
give her baby is the gift of health, This gift of health can be given to baby through proper and
adequate breast feeding1.
Breastfeeding is one of the most natural and beneficial acts a mother can do for her
child. Dramatic health benefits have been proven to pass from mother to child through breast milk
from antibodies which protect an infant at birth...to the exclusive nutrients in mother's milk which
have been shown to prevent a number of childhood diseases...the benefits are incalculable. There is
no other single action by which a mother can so impact the present and future health of her baby2.
Yet, in today's society, breastfeeding is often thought of as unnecessary. Young mothers
are mistakenly led to believe that formula does very well as a replacement for breast milk. It
emphatically does not! Nothing can duplicate the properties of breast milk, no matter how many
vitamins, minerals and supplements are added to what is basically a chemical formulaton. Breast milk
remains the one and only natural, complete and complex nutrition for human infants. It is nature's
formula for ensuring the health and quality of life for infants, as well as on through childhood to adult
life. Just as importantly, breastfeeding promotes a very special bond between mother and child that
only a mother can provide3.
There are many benefits of breast feeding, such as: Children receive the most complete and
optimal mix of nutrients and antibodies, The varying composition of breast milk keeps pace with the
infant's individual growth and changing nutritional needs, Protection against gastroenteritis, reduced
risk of chronic constipation, colic, and other stomach upsets, Protection against allergies, asthma,
Reduced risk of SIDS (sudden infant death syndrome),Decreased risk of tooth decay (cavities)
,Breastfed infants develop higher IQ's, and have improved brain and nervous system development,
Breastfeeding plays an important role in the emotional and spiritual development of babies, Antibody
response to vaccines are higher, There are factors in human milk that destroy E coli, salmonella,
streptococcus, pneumococcus....and many others4.
Studies
have
examined
breastfeeding
in
infants
is
associated
with
higher intelligence later in life. The World Health Organization suggests that`` breastfeeding is
associated with increased cognitive development in childhood."3
The new standards are based on the breastfed child as the norm for growth and
development. This brings coherence for the first time between the tools used to assess growth, and
national and international infant feeding guidelines which recommend breastfeeding as the optimal
source of nutrition during infancy. This will now allow accurate assessment, measurement and
evaluation of breastfeeding and complementary feeding5
.
The new WHO Child Growth Standards confirm that children born anywhere in the world
and given the optimum start in life have the potential to develop to within the same range of height
and weight. Naturally there are individual differences among children, but across large populations,
regionally and globally, the average growth is remarkably similar. For example, children from India,
Norway and Brazil all show similar growth patterns when provided healthy growth conditions in
early life. The new standards prove that differences in children's growth to age five are more
influenced by nutrition, feeding practices, environment, and healthcare than genetics or ethnicity3.
Many hours of the mother’s time, day and night for many months, will be spent
feeding the baby she should be supported in the feeding method of her choice and enabled to
accomplish it with skill, knowledge, confidence and pleasure. A firm mother baby attachment can be
forged during these frequent encounters, provided that day they proceed without anxiety. When
breastfeeding goes well, there is the added advantage of the mother’s sense of achievement and
satisfaction. Breast feeding must be the ideal way to feed a baby6.
6.1
NEED FOR THE STUDY
Breast feeding is the most cost-effective, health promoting and disease preventing
activity, new-mothers can perform. Breast milk is accepted as the unique natural and nutritious food,
provided by the nature for new born. Research studies shows that the significant nutritional,
developmental, psychologic, immunologic, social, economic and environmental benefits of breast
feeding3.
Breast feeding is a personal decision a mother needs to make carefully, taking full in to
account the benefits and burdens it will bring to both mother and baby. Breast feeding offers many
benefits. It helps babies get the proper nutrition and can help mothers recover from pregnancy and
delivery. Importantly, breast feeding can promote a “bond” between mother and baby. It is estimated
that approximately 62% of mothers breast-feed their children7.
The American Academy of Pediatricians and the National Association of Pediatric Nurses
Associates and Practitioners recommend breast-feeding as much as possible during the baby’s first
year. Breast milk is extremely nutritious and contains carbohydrates, proteins, and fats essential for a
baby’s health. Essential for the physical growth and development and increase the IQ level. Breast
milk also contains antibodies that help prevent infections and allergies8.
Breastfeeding rates continue to rise, with increases of about 2 percentage points in
breastfeeding initiation, and breastfeeding at 6 and 12 months. Breastfeeding initiation increased from
74.6% in 2008 to 76.9% in 2009 births. This improvement in initiation represents the largest annual
increase over the previous decade. Breastfeeding at 6 months increased from 44.3% to 47.2%;
breastfeeding at 12 months increased from 23.8% to 25.5%9.
Studies have shown that breast-feeding may help protect against infant ear infections,
allergies, diarrhea, eczema, bacterial meningitis, and other serious illnesses. Research has also shown
that breast-feeding reduces infant anemia (iron deficiency in the blood) and stomach or intestinal
infections3.
Breastfeeding and weaning of an infant are not only crucial for optimal growth and
development but also are important determinants of future physical and mental well being because of
the rapid growth spurt and development of organs and tissues during the first year of life. The
importance of breastfeeding has been emphasized in various studies and so also the imperative role of
exclusive breastfeeding to an infant and the immunological and nutritional values of breast milk10.
A study was conducted in Australia on 20 very low birth weight infants and to compare the
clinical effects of breast and bottle feeding. Five breast feedings and five bottle feedings for each
infant were observed. Weights before and after feeding were recorded. The results showed that
weight gain during breastfeeding session was more compare to the bottle feed11.
These practices play an important role in reducing child mortality and morbidity; however
it may vary among different regions and communities. In India, breastfeeding in urban areas appears
to be shaped by the beliefs of a community, which are further influenced by social, cultural, and
economic factors. A large majority of population of the country has a low income and poor education,
thus making the practice of breastfeeding the only way to give their child a fair chance of survival and
good health. The beneficial effects of breastfeeding depend on breastfeeding initiation, its duration,
and the age at which the breast-fed child is weaned. The pattern of supplementary feeding during the
first 2 years of life is increasingly recognized as important determinants of malnutrition. Malnutrition
is often associated with inappropriate feeding practices occurring during the first year of life12.
A report given by WHO revealed that feeding for less duration is one reason behind South Asia
having the world's highest number of undernourished children, with almost 40 to 50 percent of the
under-fives being wasted, stunted and underweight, they observed. These links between malnutrition
and child feeding practices have been recognized13 .
In the current scenario mothers shows reluctance breast feeding for babies to the concerns
like lack of time, body image etc. mothers who are reluctant to breast feeding for acceptable duration
may have less knowledge regarding its effects on physical and cognitive development of children. So
the researcher felt the need to find the relation between duration of breast feeding and its effect on
physical and cognitive development of school going children.
6.2
REVEW OF LITERATURE
Review of literature is a critical summary of research on a topic of interest generally prepared to put
a research problem in paper content to identify gaps and weakness on previous studies to justify a
new investigation.
In this study the review of literature is divided into specific headings as follows:
A.
Literature related to relationship between selected breast feeding practices and physical
development.
B. Literature related to relationship between selected breast feeding practices and cognitive
development.
C. Literature related to other correlational studies about breast feeding and other developmental
aspects.
LITERATURE RELATED TO RELATIONSHIP BETWEEN SELECTED BREAST FEEDIG
PRACTICES AND PHYSICAL DEVELOPMENT.
A cohort study was conducted on Duration of breast feeding and risk of developmental
delay in Taiwanese children in the year of 2011.The objective of the study was to examine the
relationship between duration of breast feeding and four developmental domains: gross motor, fine
motor, language, and personal or social skills. This study included 14,621 infants from birth to 18
months of age. The proportion of young children who had mastered specific milestones increased
consistently with longer duration of breastfeeding. The longest duration of breast feeding vs. never
breast-fed were 95% for gross motor, 95% for fine motor, 95% for language, and 95% for
personal/social skills. Children who were breast-fed for longer than 6 months had a lower risk of
developmental delay than those who were never breast-fed. Study concluded that duration of breast
feeding is positively related to young children's physiological development13.
A study was conducted on Child growth and duration of breast feeding in urban Zambia
in the year of 2005. The aim was to investigate the relationship between duration of breast feeding
and growth of children. The sample consisted of 438 children aged 0 to 59 months. After controlling
for confounding variables, duration of breast feeding was found to be associated with height for age
among children in their first two years of life, not in the later years of life. There was no significant
protective effect of breast feeding on under nutrition and acute malnutrition as measured by weight
for age and weight for height. The study concluded that duration of breast feeding is strongly
associated with the linear growth experiences of children and the association changes with the infats
age14.
A cohort study was conducted among infants on breastfeeding and developmental
delay in London 2011.The objective of the study was to explore the relationship between breast
feeding & gross and fine motor delay in infants. The study sample included all term singleton infants
who weighed >2500 g at birth and were not placed in a special care infant unit and whose mothers
participated in the first survey of the Millennium Cohort Study. The result of the study was almost
half 47% of the infants initially were exclusively breastfed, but only 3.5% of these infants were still
being fed exclusively on breast milk after 4 months of age, and 34% of infants were not breast fed.
The study concluded that Infants who were never breastfed had at least a 40% greater likelihood of
fine motor delay than infants who were given breast milk for a prolonged period15.
A correlatinal study conducted among 182 mothers in Brasil in the year of
2012.The objective of the was to investigate the association between breastfeeding and child
development & socio-economic variables. Data were collected through an initial interview about
breastfeeding; obstetric, socioeconomic, demographic and psychosocial aspects; and mother-child
interaction analysis by the Child development risk inventory. The result showed that the breastfeeding
shows statistical correlation between child development as well as physiological development of child
and mother's domestic profession & socioeconomic background. The study concluded that initiation
& early breastfeeding & its long duration is positively correlated with physiological development of
child16.
A cohort study was conducted on breast-feeding is associated with improved growth in
length, in rural Senegalese toddlers in France in the year of 2001.The study aimed to test whether prolonged
breast-feeding is associated with impaired growth. 443 children recruited from dispensaries at 2 month of age
were visited in their homes at 6-month intervals when they were approximately 1.5 to 3 y of age. Weight,
length, arm circumference, were measured. Six-month increments were analyzed in relation to breast-feeding
(breast-fed compared with weaned children or breast-feeding duration), season, and maternal housing with use
of multiple linear regression. The result shows that the duration of breast-feeding was 24.1 month. Height-forage at the age of 3 year was negatively associated with age at weaning but this association disappeared after
adjustment for height-for-age in infancy. Length increments were significantly greater in both the second and
third years of life in children breast-fed for longer durations (P < 0.05) and tended to be greater in breast-fed
than in weaned children in the second year of life (P = 0.05). In the third year of life, breast-fed children had
greater length increments than did weaned children in the subgroup with poor housing (P for interaction <
0.05). Growth in weight did not differ significantly according to breast-feeding. The study concluded that
Prolonged breast-feeding improved linear growth17.
A large randomized trial study was conducted on effects of prolonged and exclusive
breastfeeding on child height, weight, adiposity, and blood pressure at age 6.5 year in Canada in the year of
2007. The objective of the study was to promote exclusive and prolonged breastfeeding affects children's
height, weight, adiposity, and blood pressure . A total of 17,046 healthy breastfed infants were enrolled from
31 maternity hospitals and their affiliated clinics. Analysis was based on intention to treat, with statistical
adjustment for clustering within hospitals or clinics to permit inferences at the individual level. The result
showed that no significant intervention effects were observed on height, body mass index, waist or hip
circumference, or systolic or diastolic blood pressure. The study concluded that the breastfeeding promotion
intervention resulted in substantial increases in the duration and exclusivity of breastfeeding18.
LITERATURE RELATED TO RELATIONHIP BETWEEN SELECTED BREAST FEEDING
PRACTICES AND COGNITIVE DEVELOPMENT.
A cluster randomized trial study was conducted on breastfeeding and child cognitive development in
Canada in the year of 2008. The objective of the study was to assess prolonged and exclusive
breastfeeding improves children's cognitive ability at age 6.5 year.A total of 17,046 healthy
breastfeeding infants were enrolled, of whom 13,889 (81.5%) were followed up at age 6.5
years.Subtest and IQ scores on the Wechsler Abbreviated Scales of Intelligence, and teacher
evaluations of academic performance in reading, writing, mathematics, and other subjects. The result
of the study was the experimental intervention led to a large increase in exclusive breastfeeding at age
3 months and a significantly higher prevalence of any breastfeeding at all ages up to and including 12
months. The experimental group had higher means on all of the Wechsler Abbreviated Scales of
Intelligence measures, with cluster-adjusted mean differences of +7.5 for verbal IQ, +2.9 for
performance IQ, and +5.9 for full-scale IQ. Teachers' academic ratings were significantly higher in
the experimental group for both reading and writing. The study concluded that prolonged and
exclusive breastfeeding improves children's cognitive development19.
A study was conducted among using data on 2,734 sibling pairs from the National
Longitudinal Study of Adolescent Health provided persuasive evidence of a causal connection
between breastfeeding and intelligence . In another study, cited as the largest randomized trial ever
conducted in the area of human lactation, between 1996 and 1997 maternity hospitals and
polyclinics in Belarus were randomized to receive or not receive breastfeeding promotion modeled on
the Baby Friendly Hospital Initiative. Of 13,889 infants born at these hospitals and polyclinics and
followed up in 2002–2005, those who had been born in hospitals and polyclinics receiving
breastfeeding promotion had IQs that were 2.9–7.5 points higher. Since a randomized trial should
control for maternal IQ, the study concluded that prolonged and exclusive breastfeeding improves
children's cognitive development20.
A longitudinal study was conducted on find the association between duration of breastfeeding and
intelligence in two independent samples of young adults, assessed with 2 different intelligence tests in
Denmark in the year of 2002. The study showed a positive association between duration of breast
feeding & intelligence. Sample of 973 men and women and other men of 2280, born between 1959
and 1961. Both samples were divided into 5 categories according to duration of breastfeeding and
were administered the Wechsler test at an average age of 27.2 years in the sample of women and men
and Prove PriensBorge test at an average age of 28.7 years to the sample of men. Confounding factors
were considered and showed a significant positive association between duration of breastfeeding and
intelligence in both samples independently evaluated young adults, with two different tests. The study
concluded that the more time is breastfeeding, the higher the level achieved intelligence in
adulthood3.
A cohort study was conducted on infant feeding practice and childhood cognitive performance in Karnataka in
the year of 2010.
The main objective was to examine whether duration of breastfeeding and age at
introduction of complementary foods are related to cognitive performance in 9- to 10-year-old school-aged
children in South India. Examined 514 children for whom breastfeeding duration and age at introduction of
complementary foods were collected at the first-, second- and third-year annual follow-up visits.
Their cognitive function was assessed at a mean age of 9.7 years tests measuring long-term retrieval/storage,
attention and concentration, visuo-spatial and verbal abilities. The result showed that there is a positive
associations between longer duration of breastfeeding, or age of introduction of complementary foods,
and cognitive function at 9-10 years. The study concluded that there is a positive evidence suggesting a
beneficial effect of longer duration of breastfeeding on later cognitive ability21.
A cohort study was conducted on effect of breastfeeding on child development in
Australia in the year of 2001. The study aim was to further investigate this relationship and the effect of
duration of breast feeding on cognitive development. A total of 3880 children were followed from birth.
Breastfeeding duration was measured by questionnaire at 6 months of age and a Peabody Picture Vocabulary
Test Revised (PPVT-R) was administered at 5 years. PPVT-R scores were adjusted for the effects of a large
array of biological and psychosocial confounders. The relationship between breastfeeding and the mean PPVTR scores were examined using analysis of variance and multiple linear regression. The result shows mean for
those breastfed for 6 months or more was 8.2 points higher for females and 5.8 points for males when
compared to those never breastfed. The study concluded that significant benefit to child development is
conferred by breastfeeding and is related independently to longer periods of breastfeeding22.
LITERATURE RELATED TO OTHER CORRELATIONAL STUDIES ABOUT BREAST
FEEDING AND ITS OTHER DEVELOPMENTAL ASPECTS.
A study was conducted on immunological programming by breast milk creates an antiinflammatory cytokine milieu in breast-fed infants compared to formula-fed infants in Turku in the
year of 2011. The objective of the study was to determine how the mode of feeding affects infant
immunology. The role of breast feeding in reducing the risk of allergic disease remain contradictory.
Previous studies have centred on comparative analysis of breast milk and formula compositions.18
formula-fed infants with limited breast-feeding for < 3 months and 29 infants who were exclusively
breast-fed for >3 months were included in the study. Measuring simultaneously from the same serum
sample through use of a multiplexed flow cytometric assay at the ages of 1, 3, 6 and 12 months. The
serum concentrations were significantly lower in formula-fed than in breast-fed infants throughout the
first year of life.The result shows that the exclusive breast-feeding promotes an anti-inflammatory
cytokine milieu, which is maintained throughout infancy. The conclusion of the study was EBF limits
hyper-responsiveness and promotes tolerisation, possibly prohibiting the onset of allergic disease23.
A longitudinal study was conducted in 46 countries between 2002 - 2008 to assess
undernutrition, poor feeding practices, and low coverage of key nutrition interventions. The objective
of the study was to estimate the global burden of malnutrition and highlight data on child s feeding
practices and coverage of key nutrition interventions. Indicators of infant and young child feeding
practices and intervention coverage were calculated from demographic and Health Survey. The result
showed that in 2010, globally, an estimated 27% of children younger than 5 years were stunted and
16% were underweight. Fewer than half of infants were put to the breast within 1 hour of birth, and
36% of infants younger than 6 months were exclusively breastfed. one-third of 6- to 23-month-old
children met the minimum criteria for dietary diversity. The conclusion of the study shows that poor
breastfeeding and complementary feeding practices and lack of comprehensive data on intervention
coverage require urgent action to improve child nutrition24.
A study was conducted on Reviews related to examine the current trend in infant feeding in Kuala
lumpur in the year of 2011. The study aims to examine the current trend in infant feeding and the
influences of some perinatal and socio demographic factors on breast feeding.500 mothers with
singleton pregnancies and healthy infants were interviewed at 6 weeks post – partum. Only 25%
mothers were practicing EBF and 26% mothers were using EIF. In conclusions, the overall rate of
EBF 6 weeks of age in infants born in urban hospital had remained poor. The study highlights the
importance of EBF for the development of children25
6.3
STATEMENT OF THE PROBLEM
A correlational study to determine relationship between selected breastfeeding practices and selected
developmental aspect of school going children in selected urban community, Bangalore.
6.4 THE OBJECTIVES OF THE STUDY
1. To assess the selected breastfeeding practices from the mothers of school going children.
2. To assess the physical development of school going children.
3. To assess the cognitive development of school going children.
4. To find the relationship between selected breastfeeding practices and physical & cognitive
developmental aspects of school going children.
5. To find the association between selected breast feeding practices and physical & cognitive
developmental aspects of school going children with selected demographic variable of their mothers.
6.5 HYPOTHESES
H1- There will be significant relationship between selected breastfeeding practices and
physical development of school going children
H2 – There will be significant relationship between selected breast feedingpractices and
cognitive development of school going children.
H3 -- There will be significant association between selected breast feeding practices and physical
& cognitive developmental aspects of school going children with selected demographic variable.
6.6 ASSUMPTIONS
There may be some positive relationship between selected breastfeeding practices and physical &
cognitive developmental aspect of school going children.
6.7 OPERATIONAL DEFINITIONS
·
Correlational study: It is a study to find out the significant relationship between selected
breastfeeding practices and physical & cognitive developmental aspect of school going children in
selected urban community.
·
selected breastfeeding practices : In this study it refers to duration and frequency of breast feeding
followed by the mother for their children.
·
Selected developmental aspect: In this study selected developmental aspect refers to physical and
cognitive development of school going children.
·
School going children: Children in the age group 6 – 10 years are included as school going children
in this study.
6.8 DELIMITATIONS
The study is delimited to:
· School going children in selected community.
. One month of data collection period.
7. MATERIALS AND METHOD OF STUDY
7. 1. SOURCE OF DATA
School going children & their mother of selected urban community.
7.2. METHOD OF COLLECTION OF DATA
7.2.1 TYPE OF STUDY/ RESEARCH APPROACH
Descriptive study / Qualitative approach.
7.2.2 RESEARCH DESIGN
Descriptive correlational design.
7.2.3 VARIABLES
·
Research variables : selected breastfeeding practices and physical & cognitive developmental aspect.
·
Attribute variables : age, sex, occupation, economical status, educational status and types of family.
7.2.4 SAMPLING TECHNIQUE
Purposive sampling technique.
7.2.5 SAMPLING AND SAMPLING SIZE
Mother and their children age group between 6 – 10 years.
7.2.6 SELECTION CRITERIA
· INCLUSION CRITERIA
-
school going children age group between 6 – 10 years.
-
Mothers and children who are willing to participate in study.
-
Mothers who can understand English and kannada.
. EXCLUSION CRITERIA
-
School going children having any congenital abnormality.
- Children who have global developmental delay.
- pre term and low birth weight babies / twin or multiple pregnancy.
7.2.7 DURATION OF THE STUDY
One month of data collection.
7.2.8 TOOL OR INSTRUMENTS
SECTION A : Socio demographic data from mother.
SECTION B : Physical assessment tool.
SECTION C : Tool to assess cognitive development
.
7.2.9 DATA COLLECTION PROCEDURE
After obtaining formal permission from the concerned urban community authorities, the
sample will be selected by purposive sampling technique. Written consent will be taken from the
participants after explaining purpose of the study. Data will be collected from the mothers who are
able to understand the questions through self structured questionnaire and physical & cognitive
development is assessed from their school going children.
7.2.10 PLAN FOR THE STATISTICAL ANALYSIS
The data obtained will be tabulated and analyzed in terms of objectives of the study by using
descriptive and inferential statistics. The plan of data analysis is as follows:
DESCRIPTIVE STATISTICS
1. Frequency and percentage distribution will be used to identify the demographic variables.
2. Mean, mean percentage, standard deviation and chi-square will be used to determine the
relationship between the selected breastfeeding practices and selected developmental aspect.
INFERENTIAL STATISTICS
1. Karlpearsons coefficient of correlation will be used to find out the relationship
between selected breastfeeding practices and selected developmental aspect of school going
children.
2. “Chi – square” test will be used to find the association of selected breast feeding practices & selected
developmental aspect with selected demographic variables of school going children.
7.3 Does the study require any investigation or intervention on mother or human / animal, if so
describe briefly
No invasive techniques are used in this study. Only physical assessment and IQ testing is done
using pretested and validated tool.
7.4 Has ethical clearance been obtained from the institution
Yes, ethical clearance from the institution will be obtained from concerned authorities and
written consent will be taken from subject , confidentiality & anonymity of the subject will be
maintained.
8. LIST OF REFERENCES
1. Singh m.care of newborn . 6th edition .New Delhi : sagar publications; 2004.
2. Kramer MS, Risuka, K. The optimal duration of exclusive breastfeeding and benefits. WHO/NDH
2001.
3. FatouJallow&Fatoumata Fatty . Why Is Breastfeeding So Important? [online] 2010 cited August
30, 2010.
Available from: URL:
http://www.posted.ca/Towards%20Healthy%20Environments%20for%20Children.pdf
4. Kallischnigg G, Plagemann the Scientific Benefits of Breast feeding[ online ] 2009 [cited may 14,
2009
Available from URL : . http://www.phdinparenting.com/2009/05/14/the-scientific-benefits-ofbreastfeeding.
5.
Harder T, Bergmann R, Kallischnigg G, Plagemann .Group and development . American Journal
Epidemiol 2005. 162:397–403.
6. Barria RM, Santander G, Victoriano T. Factors associated with exclusive breastfeeding at 6
months postpartum in Valdivia, Chile. Journal of Human Lactation 2008. 24:439-445
7. BPNI.World breast feeding week August 1-7; healthy mother and healthy babies. Nursing journal of
India. 2002;3(8)
8. American Academy of Pediatric Dentistry, AAPD.(n.d.). Breast milk and benefits.2007.
Available from :
URL:http://www.curetoothdecay.com/Baby_Bottle_Tooth_Decay/breast_milk_cavities.htm
9. Dr. Arun Gupta. “Initiating breast feeding within one year of birth, a scientific brief”. Available from:
URL : http//worldbreastfeedingweek. org/pdf/unicefsupportletter.pdf.
10. Rebhan B, Kohlhuber M, Schwegler U, Fromme H, Abou-Dakn M, Koletzko BV. Breastfeeding
duration and exclusivity associated with infants’ health and growth: in India. ACTA Paediatr 2009.
98:974-980.
11. Gartner LM, Morton J, Lawrence R A. Breast feeding and the use of bottle feeding . Pediatrics 2005,
Number-115,496-506.
12. Edmond Karen M, Zandoh Charles. Delayed breast feeding initiation increases risk of neonatal
mortality. Pediatrics journal. 2006;117(3):
13. Amanda Sacker , Maria A. QuigleyBreastfeeding and Developmental Delay . 2011.cited 4.sep.2011
Available from : URL : http://www.ncbi.nlm.nih.gov/pubmed/19946010
14. Ng'andu NH, Watts TE. Journal of epidemiology and community health . 2005. Dec;44(4):281-5.
Available from : URL : http://www.ncbi.nlm.nih.gov/pubmed/2277248
15. Amanda Sacker , Maria A. QuigleyBreastfeeding and Developmental Delay . 2011.cited 3.feb.2011.
Available from : URL : http://www.ncbi.nlm.nih.gov/pubmed/19946010
16. Sethi V, Kashyap S, Seth V .Indian journal of pediatrics. Volume-70, Number-6,2012, 463-66.
17. Edmond Karen M, Zandoh Charles. Breast feeding and growth. Pediatrics journal. 2001;117(3):
18. Rebhan B, Kohlhuber M, Schwegler U, Fromme H, Abou-Dakn M, Koletzko BV. Breastfeeding
duration and exclusivity associated with child health and growth in canada, . ACTA Paediatric 2007.
98:974-980
19. Collet JP, Chalmers B . Archives of general psychiatry. 2008 May;65(5):578-84.
20. http://en.wikipedia.org/wiki/Breastfeeding
21. Veena SR, Krishnaveni GV, Srinivasan Kfeeding practice and cognitive performance. 2010
May;95(5):347-54..165159.
22. Daniels MC, Adair LS. Journal of nutrition. 2001 Nov;135(11):2589-95.
23. Butler JE. Immunologic aspects of breast feeding, antiinfectious activity of breast milk.2011.
3(3):255-270.
24. Narayanan Shankar, NatarajanNisha, Bawa K S.poor feeding practice and underutrition . 2008; 61(3)
25. Agarwal K N, AgarwalDevK.current trend in Infant feeding in kualalumpur. journal of pediatrics,
Volume-49, Number-393,1981, 285-9.
SIGNATURE OF CANDIDATE
9.
REMARKS OF THE GUIDE
This study will be an effective study to
support the statement that breast feeding
practices will have effect in physical and
cognitive development of school going
children.
NAME AND DESIGNATION OF
Prof. Anjana Mathew
10.
11.1.
GUIDE
H.O.D of Paediatric Nursing
K.N.N College of Nursing
CA 23/B A sector
Yelahanka New Town
Bangalore-64
SIGNATURE
11.2.
CO-GUIDE
11.3.
11.4. SIGNATURE
HEAD OF THE DEPARTMENT
Prof. Anjana Mathew
H.O.D of Paediatric Nursing
11.5.
K.N.N College of Nursing
CA 23/B A sector
Yelahanka New Town
Bangalore-64
11.6. SIGNATURE
REMARKS OF PRINCIPAL
12.1.
A relevant and feasible study which will
throw light on breast feeding practices and
development of school going children.
12.2
NAME OF THE PRINCIPAL
Prof. Mrs. Jobi Jacob
Principal
K.N.N College of Nursing
CA 23/B A sector
Yelahanka New Town
Bangalore-64
12.3
SIGNATURE