The SMDHU Infant Feeding Surveillance system was designed by the health unit to understand infant feeding practices after the first few days postpartum. (Infant feeding intention and feeding practices in first days of baby’s life are captured in BORN).
The SMDHU Infant Feeding Surveillance system is an annual survey of parents with infants who are six to 12 months old, that collects data on feeding practices at two, four and up to six months along with risk factors and other infant feeding topics. The sampling frame is the list of new parents for which a Healthy Babies Healthy Children screen was completed and sent to the health unit, from which a random sample is drawn. This information is used to understand trends over time and to explore various factors and conditions associated with infant feeding practices. The systematic collection and monitoring of surveillance data is a requirement of the Ontario Public Health Standards (OPHS) Population Health Assessment and Surveillance Protocol as well as part of maintaining Baby-Friendly Initiative designation.
Comparison Between Two Data Sources for Infant Feeding at Initiation:
BORN captures infant feeding intention and initiation, but not duration. SMDHU Infant Feeding Surveillance System captures infant feeding initiation and duration so both BORN and the SMDHU Infant Feeding Surveillance System capture initiation data.
The “any” breast milk initiation rate is very similar between the two data sources. However, the two sources differ in the exclusive breast milk initiation rate and those who were combination feeding (breast milk and a substitute). BORN exclusive initiation rates are approximately 10% higher than SMDHU Infant Feeding Surveillance exclusive initiation rates, and the complementary combination feeding rates are 10% lower.
The “any” breast milk initiation rate is very similar between the two data sources.However, the two sources differ in the exclusive breast milk initiation rate and the combination feeding (breast milk and a substitute) rate. BORN exclusive initiation rates are approximately 10% higher than SMDHU Infant Feeding Surveillance exclusive initiation rates, and the complementary combination feeding rates are 10% lower.
Possible explanations for this difference include:
- recall bias of SMDHU Infant Feeding Surveillance respondents who may not accurately remember what baby was fed from birth to discharge;
- sampling bias in SMDHU Infant Feeding Surveillance because the sampling frame is all of those who have a completed HBHC screen received by SMDHU so those people may be systematically different than those who do not have a completed screen;
- mis-interpretation of the BORN data field definition:those who enter data may be capturing infant feeding practice at the time of discharge instead of capturing all types of feeding that occurred from birth to discharge.If baby is supplemented and then returns to only breast milk, this should be captured under ‘combination feeding’ in BORN, and not exclusive breast milk.SMDHU Infant Feeding Surveillance captures those who have supplemented at one point but ‘returned to only breast milk’ in a separate category but BORN does not. The sum of the SMDHU Infant Feeding Surveillance ‘returned to only breast milk’ initiation rate of approximately 7% and the exclusive breast milk initiation rate, is within 3% of the BORN exclusive initiation rate.