Medical

Communication

Biosci. Biotech. Res. Comm. 10(2): 252-257 (2017)

An investigation on the growth of breast-fed children

and children fed with formula feed under the age of

one year in Ilam, Iran

Jasem Mohamadi

and Mohamad Reza Havasian

Department Pediatrics, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran

Department Periodontics, School of Dentistry, Ilam University of Medical sciences, Ilam, Iran

ABSTRACT

Despite global emphasis on exclusively breast feeding children during the  rst six months of life, most mothers stop

breast feeding their children. The continuation of complementary feeding can prevent various diseases and even

decrease the risk of developing asthma in childhood in vulnerable families by 50%. The present descriptive-cross

sectional study aims at investigating the growth of breastfed children and children fed with formula under the age

of one year in Ilam. The investigated population consists of all the infants who visited urban health centers in Ilam

to receive monthly care during winter in 2009. The investigated children were divided into two groups: breastfed

children and children fed with formula. Researcher-developed questionnaires were used to gather information on the

infants. The gathered data on the infants included demographic data, growth indices, and their parents’ history of

underlying diseases. The data were analyzed using SPSS version 16. In this study, 195 patients were investigated, of

whom 96 cases (49.2%) were males and 99 cases (50.8%) were females. The highest frequency was for mothers aged

24-28. Furthermore, 108 cases (55.4%) were breastfed children and 87 cases (44.6%) were children fed with formula.

Four cases (2.1%) of breastfed children and 9 cases (4.6%) of the children fed with formula suffered from FTT with

average heights. Moreover, 4 cases (2.1%) of breastfed children and 5 cases (2.6%) of the children fed with formula

suffered from FTT with average weights. The results of the study indicate that feeding children with breast milk until

the age of six months and its continuation late on can considerably decreases weight and height disorders and also

the number of admissions to the hospital due to diarrhea.

KEY WORDS: GROWTH, BREASTFED, FORMULA, CHILDREN

252

ARTICLE INFORMATION:

*Corresponding Author: havasian1991@gmail.com.

Received 12

March, 2017

Accepted after revision 20

June, 2017

BBRC Print ISSN: 0974-6455

Online ISSN: 2321-4007 CODEN: USA BBRCBA

Thomson Reuters ISI ESC and Crossref Indexed Journal

NAAS Journal Score 2017: 4.31 Cosmos IF : 4.006

reserved.

Online Contents Available at: http//www.bbrc.in/

Jasem Mohamadi and Mohamad Reza Havasian

INTRODUCTION

In recent years, there has been a global attention to

the point that the beginning years of a child’s life are a

golden opportunity for effectively promoting children’s

development.The World Health organization has high-

lighted the importance of exclusively breastfeeding chil-

dren within the  rst six months of a child’s life. Exclu-

sive breastfeeding provides an ideal diet for the child,

improves the psychological relationship between mother

and child, maintains the health of mother and child, and

brings economic bene ts, (Olds et al. 2002, Napoli et al.

2004, Mohammadi et al., 2017 and Behnampoor 2017).

Moreover, there is plenty of evidence demonstrating

the bene ts of breastfeeding, and breastfeeding is gen-

erally unavoidable (Cunningham et al. 1991). In devel-

oping countries, breastfeeding decreases infant mortal-

ity and diseases to a considerable degree. In developed

countries, a great amount of evidence indicates that

breastfeeding prevents the sudden death syndrome and

the development of diabetes in teenage ages (Park et al.

1993). Furthermore, breastfeeding decreases the risk of

gastrointestinal, urinary, and pulmonary infections and

improves child’s neural growth (Crawford et al. 1993).

In fact, the considerable growth of infants within their

 rst year of life, namely three times increase in weight,

two times increase in height, and constant physical

growth, albeit in a slower pace from the age of one year

to puberty, creates certain nutritional needs. Moreover,

unlike adults, these nutritional needs are affected by

strong maintenance needs caused by constant metabolic

and nutritional transformations in infants and children.

Also, since this fast growth is accompanied by certain

growth changes in performance and body composition,

any defect in supplying an adequate amount of nutrients

during this period of time can leave destructive effects

not only on growth but also on development (Jenson

et al. 2008).

Generally, starting feeding with breast milk within

the  rst hour of life after birth and exclusive breast-

feeding within the  rst six months of life can save the

lives of more than one million infants. Breast milk can

alone provide all the nutrients needed by an infant for

a normal growth from the  rst moment of life through

the end of the sixth month of life. Even within the  rst

few days after birth, when the normal  ow of milk in

the breast of the mother is not established, the infant

does not need any other food or drink, and that amount

of milk would be enough to ensure the infant’s natu-

ral growth. The living cells and various antimicrobial

agents in breast milk, which can be found in a higher

density in colostrum, can destroy bacteria, viruses, and

parasites and, consequently, decrease the risk of the

child being af icted with infections, particularly gastro-

intestinal and respiratory infections and the infections

of the middle ear (Mohamadi et al. 2014).

Milk powder is merely a food while breast milk is

a nutritious, organic, and complex liquid containing

antibodies, enzymes, and hormones that are all useful

for health. Besides, some methods of feeding the child

with milk powder expose the child to serious risks of

infection. Early receiving of colostrum, which is high in

antibodies, has great importance in developing coun-

tries, and small amounts of colostrum can help the

body prevent overloading the kidneys when the child

is regulating body  uid balance (Hoddinott et al. 2008).

According to international indicators, all infants should

be breastfed right after their birth and in less than one

hour after delivery, and even before they are washed

and before their cord is cut. In fact, this is now one of

the most important health indicators. To this end, there

exists a need for adequately training the medicine and

nursing team and retraining them about nutrition and

breastfeeding (Behnampoor et al. 2017). The present

study aims at investigating the growth of breastfed chil-

dren and children fed with formula under the age of one

year in Ilam.

MATERIAL AND METHODS

This is a descriptive-cross sectional study in which the

investigated population consists of all the infants who

visited nine urban health centers af liated with the health

network of Ilam province to receive monthly care dur-

ing winter in 2009. To this end, after obtaining written

permission for conducting the research from the research

of ce of Ilam University of Medical Sciences and gain-

ing approval from university’s research ethics commit-

tee, the research was carried out in the health centers

mentioned above. The investigated infants were divided

into two groups: breastfed infants and infants fed with

formula. Information about people were gathered using

two researcher-developed questionnaires that included

demographic data and growth indices such as age, sex,

their parents’ level of education and history of underlying

diseases. Parametric and non-parametric tests were used

to compare the variables and investigate the relations and

correlations among them. For this purpose, the data were

analyzed using SPSS version 16, and Chi-Square tests and

T-tests were performed (Havasian et al. 2012, Mahmoodi

et al. 2017 and Mohamadi et al. 2017).

RESULTS AND DISCUSSION

In this study, 195 patients were investigated, of whom

96 cases (49.2%) were males and 99 cases (50.8%) were

females. The highest frequency of patients was for

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS INVESTIGATION ON THE GROWTH OF BREASTFED CHILDREN AND CHILDREN FED 253

Jasem Mohamadi and Mohamad Reza Havasian

infants aged 3-6 months; they comprised 37.4% of the

infants. The lowest frequency was for infants under the

age of nine months and above; they comprised 10.7%

of the infants (Table 1). The highest frequency among

mothers was for mothers aged 24-28 years who com-

prised 32.8% of mothers, and the lowest frequency was

for mothers aged 34 and above who comprised 17.9%

of mothers (Table 2). The highest frequency for mother’s

level of education was for mothers with a diploma and

lower who comprised 64.1% of the mothers with 125

cases. Of the investigated infants, 108 cases (55.4 %)

were fed with breast milk and 87 cases (44.6%) were fed

with formula. Also, the most common reason for using

formula was lack of breast milk in 47 cases (56.4%) and

the least common reason was death of mother in two

cases (1.3%) (Table 3). Four cases of the investigated

infants in the breastfed infants group (2.1%) and nine

cases in the infants fed with formula group (4.6%) suf-

fered from FTT with average levels of height (Table 4).

Four cases of the investigated infants in the breastfed

infants group (2.1%) and  ve cases in the infants fed

with formula group (2.6%) suffered from FTT with aver-

age levels of weight (Table 5). The means for height,

weight, head circumference for breastfed infants were

62.99cm, 67kg, and 41cm, respectively. In infants fed

with formula the mean height, weight, and head cir-

cumference were 60.89cm, 63kg, and 40cm, respectively

(P>0.05). The highest number of admissions to the hos-

pital due to diarrhea and type of nutrition was two times

in three cases of the infants fed with formula (Table 6).

Infants fed with breast milk do not need water or iron

until the age of six months; the breast milk provides

all the required nutrients and liquids to maintain the

infant’s health (Martinez et al. 2002).

In fact, breastfeeding is the most important and the

most effective factor in maintaining and sustaining

infants’ health that has been approved by all academic

circles around the world (Shadzi et al. 2000). The con-

tinuation of breastfeeding after the start of comple-

mentary feeding can prevent various diseases such as

pneumonia, urinary tract infection, middle ear infec-

tion, diarrhea, bacteremia, and bacterial meningitis, and

decreases the risk of developing asthma in vulnerable

families by 50% (Weinstein et al. 2006). Weight is an

important indicator of physical growth and development

and is the simplest and, at the same time, one of the

best indicators of growth. The weight of 95% of term

infants is 2.5-4.6kg, with a mean of 3.4kg. Boys tend to

be slightly heavier than girls (Ardabili et al. 2008). An

infant loses around 5-10% of its weight within the  rst

few days after birth and returns to its weight at birth

from seven to ten days after birth (Jenson et al. 2008).

Furthermore, the bene ts of feeding infants who weigh

less than 1500 gr with breast milk has recently been

Table 1. Frequency of investigated infants by age

Age (Months) Frequency Percent

3 and Less 60 30.7

3-6 73 37.4

6-9 41 21

9 and More 21 10.7

Total 195 100

Table 2. Frequency of investigated infants by the

age of infant’s mother

Age of mother (Years) Frequency Percent

18-23 40 20.5

24-28 64 32.8

29-33 56 28.7

34 and more 35 17.9

Total 195 100

Table 3. Frequency of mothers by the reason for

feeding with formula

Reason for feeding

with formula

Frequency Percent

Weak breast milk 9 10.5

Employment of mother 24 28

Lack of breast milk 47 54.6

Disease of mother 4 5

Death of mother 2 2.3

Total 86 100

254 INVESTIGATION ON THE GROWTH OF BREASTFED CHILDREN AND CHILDREN FED BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Jasem Mohamadi and Mohamad Reza Havasian

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS INVESTIGATION ON THE GROWTH OF BREASTFED CHILDREN AND CHILDREN FED 255

Table 4. Frequency of investigated infants by height FTT and type of nutrition

Kind of Nutrition

Height FTT

Fed with Formula Breastfed

Total

Frequency Percent Frequency Percent

Lack of FTT 57 29.2 84 43.1 141

Light 16 8.2 15 7.7 31

Moderate 9 4.6 4 2.1 13

Severe 5 2.6 5 2.6 10

Total 87 44.6 108 55.4 195

Table 5. Frequency of investigated infants by weight FTT and type of nutrition

Kind of Nutrition

Weight FTT

Fed with Formula Breastfed

Total

Frequency Percent Frequency Percent

Lack of FTT 56 28.7 82 42.1 138

Light 22 11.3 21 10.8 43

Moderate 5 2.6 4 2.1 9

Severe 4 2.1 1 0.5 5

Total 87 44.6 108 55.4 195

Table 6. Frequency of investigated infants by the number of admissions to the hospital due to

diarrhea and the type of nutrition

Kind of Nutrition

Reason for admission

Fed with Formula Breastfed

Total

Frequency Percent Frequency Percent

Without disease history 79 40.5 104 53.3 183

Once 5 2.6 4 2.1 9

Twice 3 1.5 0 0 3

Total 87 44.6 108 55.4 195

recognized, and breastfeeding is the most preferable

way of feeding infants (Schanler et al. 2005). Given the

above-mentioned discussion, the present study investi-

gated the growth of breastfed children and children fed

with formula in Ilam. In the study of Ziaa et al 2009,

which was conducted to investigate the effect of type of

delivery on the success of breastfeeding, breastfeeding

had started within the  rst hour after delivery by 207

mothers (60%) Findings of Islami et al. (2008), also cor-

respond with the results found in the present study.

The results of Jokar et al (2009), which investigated

the effects of auxiliary nutrition in children under the

Jasem Mohamadi and Mohamad Reza Havasian

256 INVESTIGATION ON THE GROWTH OF BREASTFED CHILDREN AND CHILDREN FED BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

age of on year who had visited clinics in Ilam, indicated

that 69.9% of the mothers were housewives, and most

of them were aged 18-24 years, and most of them had

a diploma or a lower degree of education (Jokar et al.

2008), which are in line with the results of the present

study. In another study, it was reported that the preva-

lence of giardia infection was 45.5% among infants fed

with breast milk, 9.3% in infants fed with milk powder,

and 17.7% in infants fed with cow milk (Ghorbani et al.

2008). In the present study, admission to the hospital

for more than one time was signi cantly higher among

infants fed with formula. In Mihrshahi et al (2003), which

investigated the relationship between the prevalence of

respiratory infections and the length of exclusive feed-

ing of infants with breast milk, it was reported that the

prevalence of respiratory diseases is related with shorter

periods of exclusive feeding with breast milk (Mihrshahi

et al. 2007), a  nding in line with the results of the present

study.

In Helena et al 2008, which investigated the effect of

breastfeeding on the growth of 479 infants in a health

center in Brazil, the results of the study showed that,

despite a faster growth in the beginning months of

their lives, breastfed children reached lower weight and

height balances compared to infants fed with milks other

than breast milk in the same period of time (Spyrides

et al. 2008). However, in the present study, the means

for height and weight disorders in infants fed with for-

mula was higher than the means for breastfed children,

a  nding not in line with Helena et al, 2008. Generally,

in many studies, mothers have stated that they are not

supported by health staff and do not have access to them

when they need them. In fact, mothers point to lack of

access to health staff as an impeding factor in sustain-

ing breastfeeding, which is line with the results of the

present study.

CONCLUSION

The results of the present study indicated that breast-

feeding until the age of six months and its continuation

late on can considerably decrease weight and height dis-

orders and the number of admissions to the hospital due

to diarrhea. We suggested that further research be done

to investigate different aspects of breastfeeding and the

importance of educating mothers who visit health cent-

ers about the problems and disadvantages of feeding

with formula.

REFERENCES

Ardabili E, Rafaie-Shirpak H. (2008). Public Health. Ministry of

Health and Medical Education. 3

Edition.

Behnampoor M, Havasian MR, Sargolzaei N, Mahmoodi Z,

Salarzaei M, Mohamadi J. (2017). Investigating the Mortality

Causes of 1-59 Months Babies of Village from 2012 to 2015,

Zahedan, Iran. Indo Am. J. P. Sci. 4(05): 1079-84.

Crawford MA. (1993). The role of essential fatty acids in neural

development: implications for perinatal nutrition. The Ameri-

can journal of clinical nutrition. 57(5): 703S-9S.

Cunningham AS, Jelliffe DB, Jelliffe EP. (1991). Breast-feeding

and health in the 1980s: a global epidemiologic review. The

Journal of pediatrics. 118(5): 659-66.

Ghorbani R, Sadat-Hashemi SM, Pazooki R. (2008). Does

breast-feeding protect the child from Giardia lamblia infec-

tion?. J of Tehran Uni Med. 66(6): 425-31.

Havasian MR, Panahi J, Khosravi A. (2012). Correlation

between the lipid and cytokine pro les in patients with coro-

nary heart disease (CHD)(Review article). Life Science Journal.

9(4): 5772-77.

Hoddinott P, Tappin D, Wright C. (2008). Breast feeding. BMJ.

336(7649): 881-87.

Islami Z, Fallah R, Golestan M, Shajaree A. (2008). Relation-

ship between Delivery Type and Successful Breastfeeding. Iran

J Pediatr. 18(Suppl 1): 47-52.

Jenson MD. (2008). Nelson textbook of pediatrics, 18

Edition.

Jokar F, Taheri-Ezirmi Z, Yeganeh MR. (2008). Supplementary

nutrition status of children under one year old in Ilam clinics.

J of Hayat. 14(1): 61-8.

Mahmoodi Z, Havasian MR, Esmail-Zahikurin, Salarzaei M.

(2017). Investigating Critical Blood Pressure Risk Factors in

Zabol, Amir-Al-Momenin Hospital Patients in 2015-2016. Indo

Am. J. P. Sci. 4(05): 1183-87.

Martinez CS. (2002). FNRI Recommends Exclusive Breast-

Feeding for the First Six Months.

Mihrshahi S, Ichikawa N, Shuaib M, Oddy W, Ampon R, Dibley

MJ, Kabir AI, Peat JK. (2007). Prevalence of exclusive breast-

feeding in Bangladesh and its association with diarrhoea and

acute respiratory infection: results of the multiple indicator

cluster survey 2003. Journal of Health, Population and Nutri-

tion. 25(2): 195-204.

Mohamadi J, Darabi M, Havasian MR. (2017). Investigating the

Causes of Infant Mortality in Imam-Khomeini and Mustafa-

Khomeini Hospitals, Ilam, 2012 To 2016. Indo Am. J. P. Sci.

4(06): 1431-37.

Mohamadi J, Motaghi M, panahi J, Havasian MR, Delpisheh A,

Azizian M, Pakzad I. (2014). Anti-fungal resistance in candida

isolated from oral and diaper rash candidiasis in neonates. Bio-

information. 10(11): 667-70.

Napoli A, Lallo D, Fortes C, Franceschelli C, Armeni E, Guas-

ticchi G. (2004). Home breastfeeding support by health profes-

sionals:  ndings of a randomized controlled trial in a popula-

tion of Italian women. Acta Paediatrica. 93(8):1108-14

Olds LD. (2002). Prenatal and infancy home visiting by nurses:

from randomized trials to community replication. Prevention

Science. 3(3):153-72.

Jasem Mohamadi and Mohamad Reza Havasian

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS INVESTIGATION ON THE GROWTH OF BREASTFED CHILDREN AND CHILDREN FED 257

Park P. (1993). Cow’s milk linked to juvenile diabetes. New

Scientist. 22(5): 1835-39.

Schanler RJ. (2005). Enteral nutrition for the high-risk neo-

nate. Taeusch WH, Ballard RA, Gleason CA: Avery’s Diseases

of the Newborn, Ed Elsevier Saunders.

Shadzi SH. (2000). Principles to children’s health. Isfahan,

Kankash publication.

Spyrides MH, Struchiner CJ, Barbosa MT, Kac G. (2008). Effect

of predominant breastfeeding duration on infant growth: pro-

spective study using nonlinear mixed effect models. Jornal de

pediatria. 84(3): 237-43.

Weinstein ME, Oleske JM, Bogden JD. (2006). A selected review

of breast-feeding recommendations. Nutrition research. 26(8):

379-84.