Laurence M Grummer-Strawn

• PhD
• Technical Officer at World Health Organization WHO

The complementary feeding period (6–24 months) is a window of opportunity for preventing stunting, wasting, overweight, and obesity and for improving long‐term development and health. Because WHO published its guiding principles for complementary feeding in 2003, new knowledge and evidence have been generated in the area of child feeding. The aim o...

Written by the WHO/UNICEF NetCode author group, the comment focuses on the need to protect families from promotion of breast-milk substitutes and highlights new WHO Guidance on Ending Inappropriate Promotion of Foods for Infants and Young Children. The World Health Assembly welcomed this Guidance in 2016 and has called on all countries to adopt and...

Hemoglobin (Hb), mean cell volume (MCV), and erythrocyte protoporphyrin (EP) are commonly used to screen for iron deficiency (ID), but systematic evaluation of the sensitivity and specificity of these tests is limited. The objective of this study is to determine the sensitivity and specificity of Hb, MCV, and EP measurements in screening for ID in...

Care immediately following birth affects breastfeeding outcomes. This analysis compared improvement in maternity care practices from 2011 to 2013 among hospitals participating in a quality improvement collaborative, Best Fed Beginnings (BFB), to hospitals that applied but were not selected (non–Best Fed Beginnings [non-BFB]), and other hospitals, u...

Background Understanding state/territorial trends in obesity by race/ethnicity helps focus resources on populations at risk.Objective This study aimed to examine trends in obesity prevalence among low-income, preschool-aged children from 2008 through 2011 in U.S. states and territories by race/ethnicity.Methods We used measured weight and height re...

Background: Although 80% of U.S. mothers begin breastfeeding their infants, many do not continue breastfeeding as long as they would like to. Experiences during the birth hospitalization affect a mother's ability to establish and maintain breastfeeding. The Baby-Friendly Hospital Initiative is a global program launched by the World Health Organiza...

Racial/ethnic differences in recent obesity trends have not been reported among young low-income children. The purpose of this study is to examine trends in obesity prevalence from 1998 through 2011 by race/ethnicity among low-income children aged 2-4 years. The study was based on measured weight and height records of 29,040,851 participants of fed...

Background: Breastfeeding provides numerous health benefits; however, many infants are not breastfed as long as their mothers’ desire. Maternal employment has been cited as a barrier to breastfeeding. We assessed whether maternity leave duration and return-status (full-time [FT], part-time [PT]) were associated with not meeting intentions to breast...

Breastfeeding is a highly effective preventive measure a mother can take after birth to protect the health of her infant, as well as her own. Immunologic and antiinflammatory properties of breast milk protect against numerous illnesses and diseases in children. Benefits of breastfeeding for infants include a lower risk for ear infections, atopic de...

* Abbreviations: DOHaD — : developmental origins of health and disease IFPS II — : Infant Feeding Practices Study II In 1986, the late David Barker described a link between intrauterine growth and ischemic heart disease,1 originating a field of medical and anthropological research known as the fetal origins of health and disease. More recently, th...

Background: Previous studies have shown that breastfeeding is associated with reductions in the risk of common infections among infants; however, whether breastfeeding confers longer term protection is inconclusive. Methods: We linked data from the 2005-2007 IFPS II (Infant Feeding Practices Study II) and follow-up data collected when the childr...

Objective: We describe methods used in the Year 6 Follow-Up (Y6FU) of children who participated in the Infant Feeding Practices Study II (IFPSII). This study consists of a questionnaire administered 6 years after the IFPSII to characterize the health, development, and diet quality of the children. Methods: The Y6FU sample was a subset of those w...

Despite the well documented health benefits of breastfeeding, initiation of breastfeeding and breastfeeding duration rates among black infants in the United States are approximately 16% lower than among whites. Although many factors play a role in a woman's ability to breastfeed, experiences during the childbirth hospitalization are critical for es...

Background: Eating more fruits and vegetables adds underconsumed nutrients to diets, reduces the risks for leading causes of illness and death, and helps manage body weight. This report describes trends in the contributions of fruits and vegetables to the diets of children aged 2-18 years. Methods: CDC analyzed 1 day of 24-hour dietary recalls f...

Background: Breastfeeding provides numerous health benefits for infants and mothers; however, many infants are not breastfed as long as recommended or desired by mothers. Maternal employment is frequently cited as a barrier to breastfeeding. Objective: This study aimed to assess whether maternity leave duration and return status (full-time [FT],...

Background: The American Academy of Pediatrics recommends 6 months of exclusive breastfeeding, however, only 16% of US infants meet this recommendation. Shorter exclusive/predominant breastfeeding durations have been observed from women who return to work early and/or full-time. Objective: We assessed the relationship between prenatal plans for...

Universal prenatal daily iron-folic acid (IFA) and multiple micronutrient (MM) supplements are recommended to reduce the risk of low birth weight, maternal anemia, and iron deficiency (ID) during pregnancy, but the evidence of their effect on iron status among women with mild or no anemia is limited. The aim of this study was to describe the iron s...

Background: A substantial proportion of US maternity care facilities engage in practices that are not evidence-based and that interfere with breastfeeding. The CDC Survey of Maternity Practices in Infant Nutrition and Care (mPINC) showed significant variation in maternity practices among US states. Objective: The purpose of this article is to us...

Objective: To examine the incidence and reverse of obesity among young low-income children and variations across population subgroups. Methods: We included 1.2 million participants in federally funded child health and nutrition programs who were 0 to 23 months old in 2008 and were followed up 24 to 35 months later in 2010-2011. Weight and height...

In the United States, about 25% of women choose not to initiate breastfeeding, yet little is known about how opinions of individuals in a woman's support network influence her decision to breastfeed. In the 2005-2007 Infant Feeding Practices Study II, women completed questionnaires from the last trimester of pregnancy until 12 months postpartum. Mo...

Background: Previous studies have shown that breastfeeding is associated with significant reductions in the risk of common infections among infants in developed countries; however, whether breastfeeding confers longer-term protection against infections is unknown. Methods: We linked data from the 2005-2006 Infant Feeding Practices Study-II and 2012...

Background: The prevalence of obesity among U.S. preschoolers has doubled in recent decades. Childhood obesity increases the risk for adult obesity and is associated with negative health consequences. Trends in the state-specific prevalence of obesity among low-income U.S. preschool children have not been examined since 2008. State-specific obesit...

Although pregnant women and some groups of reproductive-age women in the US may be at risk of iodine deficiency, data also suggest that iodine intake among many U.S. children may be above requirements. Our objective was to describe the association of iodine sources with iodine status among children. We analyzed 2007-2010 NHANES data of urine iodine...

Our objective was to examine the incidence of obesity (BMI‐for‐age ≥ 95th percentile based on CDC growth charts) among young low‐income children. We included 1 million nonobese participants in federally‐funded child health and nutrition programs aged 0–23 months in 2008 and examined their incidence of obesity in 2011. Weight and height were measure...

To describe the prevalence and factors associated with not meeting desired breastfeeding duration. Data were analyzed from 1177 mothers aged ≥18 years who responded to monthly surveys from pregnancy until their child was 1 year old. When breastfeeding stopped, mothers were asked whether they breastfed as long as they wanted (yes or no) and to rate...

Abstract Breastfeeding has important consequences for women's health, including lower risk of breast and ovarian cancers as well as type 2 diabetes. Although most pregnant women want to breastfeed, a majority encounter difficulties and are not able to breastfeed as long as they want. Routine maternity care practices can pose significant barriers to...

Few school-age youth consume the recommended amounts of fruits and vegetables, and increasing fruit and vegetable intake in children and adolescents is an important public health goal to maintain long-term good health and to decrease risk of chronic disease and obesity. School salad bars are an important tool to promote fruit and vegetable consumpt...

Serum soluble transferrin receptor (sTfR) is recommended as a sensitive and accurate measure of iron deficiency (ID) in populations when only a single indicator can be used. The lack of assay standardization and of representative data on the distribution of sTfR in at-risk populations currently limits its utility. Using data from NHANES 2003-2010,...

To describe mothers' exclusive breastfeeding intentions and whether Baby-Friendly hospital practices are associated with achieving these intentions. In the 2005-2007 Infant Feeding Practices Study II, women completed a prenatal questionnaire and approximately monthly questionnaires through 12 months. Mothers met their prenatal exclusive breastfeedi...

To better understand the mechanisms behind breastfeeding and childhood obesity, we assessed the association of weight gain with the mode of milk delivery aside from the type of milk given to infants. A longitudinal study of infants followed up from birth to age 1 year. Multilevel analyses were conducted to estimate infant weight gain by type of mil...

To estimate the proportions of US infants who were breastfed exclusively for 6 months, according to characteristics of the mother, child, and household environment, and to compare associations between those characteristics and exclusive breastfeeding with associations between those characteristics and breastfeeding initiation. Data were obtained fr...

Background: Many mothers in the US choose not to initiate breastfeeding. This study examines maternal perceptions of family members' and clinicians' opinion of how the newborn infant should be fed as factors related to mother's decision not to breastfeed. Methods: The Infant Feeding Practices II study followed mothers from the last trimester of pre...

The Surgeon General issued a Call to Action to Support Breastfeeding on January 20, 2011. This presentation will review the creation of the Call to Action and its twenty action steps related to the ways that families, communities, employers and health care professionals can improve breastfeeding rates and increase support for breastfeeding.

Less than 10% of adolescents eat 3+ servings of fruit and 2+ servings of vegetables daily. The school cafeteria is an ideal setting to promote healthy eating habits. Introduction of school salad bars is a proven way to increase the amount and variety of fruits and vegetables (F&V) consumed by children in K-12 schools. In 2010, the National Fruit an...

There is limited data on prepregnancy obesity trends specifically among low-income women, a population at high risk for obstetric complications. Using the Pregnancy Nutrition Surveillance System, we assessed prepregnancy obesity [body mass index (BMI) ≥ 30 kg/m(2)] trends among women who participated in the Supplemental Nutrition Program for Women,...

We examined trends in breastfeeding promotion investments, breastfeeding promotion activities, and breastfeeding duration in Latin America and the Caribbean from the 1980s to the 2000s. We obtained financial data from the United States Agency for International Development and the International Code Documentation Center, and we obtained breastfeedin...

Background: Childhood obesity is a national epidemic in the United States. Increasing the proportion of mothers who breastfeed is one important public health strategy for preventing childhood obesity. The World Health Organization and United Nations Children's Fund (UNICEF) Baby-Friendly Hospital Initiative specifies Ten Steps to Successful Breastf...

Longitudinal data with 37 964 length and weight measurements from 10 844 children who participated in the California Child Health and Development Study was used to compare the proportion of children aged ≤24 months who crossed major percentile lines on the Centers for Disease Control and Prevention (CDC) 2000 growth charts with the percentage who c...

Total body iron calculated from serum ferritin and soluble transferrin receptor concentrations allows for the evaluation of the full range of iron status. We described the distribution of total body iron and the prevalence of iron deficiency (ID) on the basis of total body iron in US pregnant women. We examined data from the National Health and Nut...

Background: Three infants were recently reported to have been HIV-infected through eating food prechewed by HIV-infected caregivers. We examined the prevalence of and factors influencing maternal premastication feeding practices amongst U.S. mothers in the Infant Feeding Practices Study II (IFPS II). Methods: The IFPS II was a longitudinal study fo...

The CDC is strongly committed to the promotion and support of breastfeeding in the United States. Key activities for CDC in 2010 include: 1) funding and technical assistance to state health departments, 2) coordination of the Call to Action To Support Breastfeeding, 3) development of the Healthy People 2020 objectives on breastfeeding, 4) completio...

Only 14% of adults meet national objectives for both fruit and vegetable (FV) consumption and most need improvement in overall diet quality. Greater access to healthier foods such as FV is associated with better diet, decreased obesity and decreased chronic disease. Policies that support FV access can lead to increased FV consumption. We therefore...

In April 2006, the World Health Organization (WHO) released new international growth charts for children aged 0-59 months. Similar to the 2000 CDC growth charts, these charts describe weight for age, length (or stature) for age, weight for length (or stature), and body mass index for age. Whereas the WHO charts are growth standards, describing the...

Background: Breastfeeding has large benefits for mothers and infants. The short-term benefits for child survival and reduced morbidity differ by population subgroup because of differences in underlying risk factors. Although breastfeeding is more common among poor than well-off women, how breastfeeding patterns change between these subgroups is im...

How breastfeeding reduces the risk of childhood obesity is unclear, and 1 hypothesis pertains to the ability of breastfed infants to self-regulate. We studied whether infants' self-regulation of milk intake is affected by feeding mode (bottle versus breast) and the type of milk in the bottle (formula versus expressed breast milk). Participants in t...

The 1984 Surgeon General's Workshop on Breastfeeding delineated six priority areas for action to protect, promote, and support breastfeeding. In this article, we examine trends in breastfeeding behaviors and recall key events and actions that shaped these behaviors over the past 25 years. We examine progress in breastfeeding support through workpla...

Evidence shows that hospital-based practices affect breastfeeding duration and exclusivity throughout the first year of life. However, a 2007 CDC survey of US maternity facilities documented poor adherence with evidence-based practice. Of a possible score of 100 points, the average hospital scored only 63 with great regional disparities. Inappropri...

School-based BMI measurement has attracted attention across the nation as a potential approach to address obesity among youth. However, little is known about its impact or effectiveness in changing obesity rates or related physical activity and dietary behaviors that influence obesity. This article describes current BMI-measurement programs and pra...

A new index to determine body iron promises a simpler approach to monitoring iron deficiency (ID) prevalence. Our objective was to compare ID defined as body iron <0 mg/kg and calculated from the log ratio of transferrin receptor to ferritin (the body iron model) to ID defined as >/=2 of 3 abnormal concentrations in ferritin, transferrin saturation...

We sought to determine the impact of sociodemographic and behavioral factors and state legislation on breastfeeding initiation (child ever fed breastmilk) and duration. We used data from a nationally representative study of children aged 6 to 71 months (N = 33 121); we calculated unadjusted and adjusted state estimates for breastfeeding initiation...

This supplemental issue of Pediatrics presents the first set of results from the Infant Feeding Practices Study II (IFPS II), which were chosen to cover a wide range of the topics included in the study. The IFPS II was conducted collaboratively by the Food and Drug Administration and the Centers for Disease Control and Prevention (CDC) and was co-f...

Our goal is to describe the methods used in the Infant Feeding Practices Study II (IFPS II), a study of infant feeding and care practices throughout the first year of life. Survey topics included breastfeeding, formula and complementary feeding, infant health, breast-pump use, food allergies, sleeping arrangements, mother's employment, and child ca...

Infancy is a time of rapid transition from a diet of virtually nothing but milk (either breast milk or infant formula) to a varied diet from nearly all food groups being consumed on a daily basis by most infants. Despite various recommendations about infant feeding, little is known about actual patterns of feeding among US infants. This article doc...

Our goal was to assess the impact of "Baby-Friendly" hospital practices and other maternity-care practices experienced by mothers on breastfeeding duration. This analysis of the Infant Feeding Practices Study II focused on mothers who initiated breastfeeding and intended prenatally to breastfeed for >2 months, with complete data on all variables (n...

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 in the 2005-2007 Infant Feeding Practices Study II rec...

Our goal was to determine why women stop breastfeeding at various times during their infant's first year. We analyzed self-reported data from 1323 mothers who participated in the Infant Feeding Practice Study II. Mail questionnaires were sent to mothers approximately 2, 3, 4, 5, 6, 7, 9, 10 1/2, and 12 months after their child's birth, in which the...

Our goal was to test the hypothesis that infants who were breastfed more intensively during early infancy (< or = 6 months) will be less likely to have excess weight during late infancy (> 6 months) and to examine the independent impact of infant-initiated bottle emptying and mothers' encouragement of bottle emptying on infants' risk for excess wei...

As infants transition from a milk-based diet to one that includes most food groups, the timing of the transition, how infants are fed, and the quality of their diet can have important health implications. Our objective is to describe these factors for US infants. We analyzed data from the Infant Feeding Practices Study II. Sample sizes varied for r...

Primary prevention of iron deficiency requires adequate iron intake. Although recommendations exist to promote adequate intake of iron among infants through iron-rich foods and iron supplements, few studies have examined adherence to these recommendations. Our objectives were to describe the consumption of iron-rich foods, oral iron supplements, an...

Background: CDC's Breastfeeding Report Card United States illustrates annual progress on indicators of breastfeeding protection, promotion, and support across all states. Methods: First introduced in 2007, the Breastfeeding Report Card captures features of breastfeeding-friendly communities via indicators of hospital, health professional, and pee...

Background: Hospital breastfeeding support is critical to successful initiation of lactation and long-term breastfeeding outcomes. Methods: From August 2007 through January 2008, CDC conducted a census of all U.S. birth facilities (hospitals and birth centers), assessing breastfeeding-related maternity care practices in terms of policies, personn...

To provide researchers with an unambiguous definition of anaemia using haemoglobin. Review of recommendations by expert groups and review of the literature. This report provides an unambiguous approach to haemoglobin adjustments to define anaemia using international criteria. When determining anaemia using haemoglobin, it is important to account fo...

To compare the prevalence of shortness, underweight, and overweight by using the Centers for Disease Control and Prevention (CDC) 2000 and the World Health Organization (WHO) 2006 growth charts. These comparisons are undertaken with 2 sets of cutoff values. Data from the National Health and Nutrition Examination Survey 1999-2004 were used to calcul...

Thyrotoxicosis is produced by excessive quantities of thyroid hormone. Its most common causes involve inflammation of the thyroid gland. Much more rarely, thyrotoxicosis is due to exogenous intake of thyroid hormones or iodide compounds. Few outbreaks are documented. In 2003 to early 2004, doctors in Minas, Uruguay noted a sharp increase in the inc...

The Women, Infants, and Children (WIC) branch of the Hawaii Department of Health encourages and assists mothers in breastfeeding. A study was done to determine whether an electric breast pump (vs. a manual pump) would increase breastfeeding duration in those returning to work or school full-time. During 2002-2003, a randomized trial was conducted a...

To examine the accuracy of self-reported height and weight data to classify adolescent overweight status. Self-reported height and weight are commonly used with minimal consideration of accuracy. Eleven studies (4 nationally representative, 7 convenience sample or locally based). Peer-reviewed articles of studies conducted in the United States that...

Background: School-based body mass index (BMI) measurement has attracted much attention across the nation from researchers, school officials, legislators, and the media as a potential approach to address obesity among youth. Methods: An expert panel, convened by the Centers for Disease Control and Prevention (CDC) in 2005, reviewed and provided...

To examine determinants of breastfeeding cessation by different weaning ages, we compared reasons mothers give for stopping breastfeeding at <1, 1-2, 3-5, 6-8, >9 months. Based on a total of 32 reasons surveyed on a Likert scale in the Infant Feeding Practices Study II, we estimated percentage of mothers considering each reason as important for sto...

In April of 2006, the World Health Organization (WHO) released a new international growth standard for young children birth to 5 years of age. The CDC 2000 growth reference, currently in use in the United States, describes growth of U.S. children from birth to 20 years of age. The CDC and WHO growth charts differ in their overall approach to descri...

The Infant Feeding Practices Study II is a longitudinal mail survey of adult mothers from late pregnancy through their infant's first year of life. Data were collected from May 2005 through March 2007. The purposes of the study were to understand the infant feeding practices of mothers of healthy, near or full-term singleton infants and to evaluate...

Although data on how many women breastfeed and for how long, few studies have described how breastfeeding is practiced in the U.S. Using data from the Infant Feeding Practices Study II, a longitudinal survey of 2,000 mothers, we characteristics of breastfeeding and breast milk expression. We analyze number of feeds per day, length of feeds, how fee...

Attempts to understand determinants of anemia and iron deficiency have led researchers to examine the role of Helicobacter pylori infection. The current study assessed determinants of anemia and iron deficiency, including H. pylori, in Alaska Native children. In 1999, a population-based survey was conducted among 86 children (67% response rate), me...

To determine the prevalence of alcohol consumption among breastfeeding and non-breastfeeding women at 3 months postpartum. We analyzed the most recent data available, which were from the 1993-1994 Food and Drug Administration Infant Feeding Practices Study I, a longitudinal panel study of infant-mother pairs. Self-reported data on alcohol consumpti...

Several investigators have concluded that the waist-to-height ratio is more strongly associated with cardiovascular disease risk factors than is the body mass index (BMI; in kg/m(2)). We examined the relation of the BMI-for-age z score and waist-to-height ratio to risk factors (lipids, fasting insulin, and blood pressures). We also compared the abi...

Height- and weight-based anthropometric indicators are used worldwide to characterize the nutritional status of populations. Based on the 1978 WHO/National Center for Health Statistics (NCHS) growth reference, the World Health Organization has previously indicated that the standard deviation (SD) of Z-scores of these indicators is relatively consta...

The purpose of this work was to validate the performance of age- and gender-specific BMI, triceps, and subscapular skinfold for the classification of excess of body fat in children and adolescents and to examine how much additional information these 2 skinfold measurements provide to BMI-for-age. The receiver operating characteristic curve was used...

We examined the associations of breastfeeding initiation and duration with language and motor skill development in a nationally representative sample of US children aged 10 to 71 months. Using cross-sectional data on 22399 children from the 2003 National Survey of Children's Health, we examined relationships between breastfeeding practices and chil...

Data from the HealthStyles survey, an annual national mail survey to US adults, were examined to understand changes in public attitudes toward breastfeeding. The 1999 and 2003 HealthStyles surveys included four breastfeeding items related to public attitudes toward breastfeeding in public and toward differences between infant formula and breastmilk...

Previous studies have found that breastfeeding may protect infants against future overweight. One proposed mechanism is that breastfeeding, as opposed to bottle feeding, promotes maternal feeding styles that are less controlling and more responsive to infant cues of hunger and satiety, thereby allowing infants greater self-regulation of energy inta...

Aim: To describe the WHO Multicentre Growth Reference Study (MGRS) sample with regard to screening, recruitment, compliance, sample retention and baseline characteristics. Methods: A multi-country community-based study combining a longitudinal follow-up from birth to 24 mo with a cross-sectional survey of children aged 18 to 71 mo. Study subpopulat...

The American Academy of Pediatrics recommends breastfeeding for at least the first year of life, and beyond for as long as mutually desired by mother and child. Not breastfeeding is associated with increased health risks for children, including otitis media, respiratory tract infections, diarrhea, and necrotizing enterocolitis. In addition, breastf...

The World Health Organization (WHO), in collaboration with a number of research institutions worldwide, is developing new child growth standards. As part of a broad consultative process for selecting the best statistical methods, WHO convened a group of statisticians and child growth experts to review available methods, develop a strategy for asses...

The World Health Organization (WHO), in collaboration with a number of research institutions worldwide, is developing new child growth standards. As part of a broad consultative process for selecting the best statistical methods, WHO convened a group of statisticians and child growth experts to review available methods, develop a strategy for asses...