儿童保健母乳喂养指导门诊首次就诊母婴的现状调查

Current situation of mother-infant-dyads at their first visit to breastfeeding counseling clinic

目的分析儿童保健母乳喂养指导门诊首次就诊母婴的现状,为促进婴儿期母乳喂养提供依据。方法回顾性分析2019年1月至2019年12月于南京市妇幼保健院儿童保健母乳喂养指导门诊首次就诊的581对母婴的相关资料,包括母婴的一般情况、就诊的主观原因和实际原因。根据婴儿就诊时日龄分为小日龄组(60 d及以下,n=316)、中日龄组(61~120 d,n=178)、大日龄组(121 d及以上,n=87)。分析各组间纯母乳喂养率以及就诊主观原因和实际原因的差异。采用方差分析、Kruskal-Wallis秩和检验、χ2检验或Fisher精确概率检验等进行统计学分析。结果581例婴儿的就诊日龄集中在生后30~34、41~45、90~94 d,分别占9.3%(54例)、25.3%(147例)和9.0%(52例)。就诊时总纯母乳喂养率为71.8%(417例),小、中、大日龄组婴儿就诊时纯母乳喂养率分别为67.7%(214/316)、79.8%(142/178)、70.1%(61/87),差异有统计学意义(χ2=14.249,P=0.006),两两比较中日龄组母乳喂养率显著高于小日龄组(P<0.05)。就诊的主观原因前3位依次是体重增长缓慢249例(42.9%)、担心乳汁不足142例(24.4%)和喂哺困难132例(22.7%);但实际就诊原因前3位是婴儿含接或吸吮问题165例(28.4%)、母乳喂养相关知识不足149例(25.6%)和母亲喂哺技能问题140例(24.1%)。小日龄组婴儿有较明显的含接或吸吮问题和母亲喂哺技能问题[分别为39.6%(125/316)和25.9%(82/316)],大日龄组婴儿主要为母乳喂养相关知识不足问题[48.3%(42/87)]。主观原因与实际原因进行比较,发现两者符合率较低,主观原因前3位体重增长缓慢、担心乳汁不足、喂哺困难与实际原因符合率仅1.2%(3例)、6.3%(11例)和21.2%(28例)。结论1岁以下不同日龄婴儿均存在母乳喂养相关问题,首次就诊主观原因与实际干扰母乳喂养的问题差异大,针对不同日龄婴儿给予个性化的母乳喂养指导至关重要。

Objective To analyze the current situation of the mothers and infants at their first visit to the breastfeeding counseling clinic,and provide a reference for promoting breastfeeding in infancy.Methods Clinical data of 581 mother-infant-dyads visiting the breastfeeding counseling clinic of Nanjing Maternal and Child Health Hospital from January 2019 to December 2019 were collected and analyzed retrospectively,including the general information of the dyads,and the subjective and actual reasons for visits.According to the age of infants coming to the clinics,they are divided into the younger group(60 d and below,n=316),middle-aged group(61-120 d,n=178),and older group(121 d and above,n=87).Differences in exclusive breastfeeding rate and reasons for visits between different groups were analyzed by analysis of variance,Kruskal-Wallis rank sum test,Chi-square test,or Fisher's exact test.Results The age of the 581 infants at the first visit were mainly at 30-34,41-45 and 90-94 d,which accounted for 9.3%(n=54),25.3%(n=147),and 9.0%(n=52),respectively.The total exclusive breastfeeding rate was 71.8%(n=417)at visit,and there were significant differences among the younger,middle-aged and older group[67.7%(214/316),79.8%(142/178),70.1%(61/87),χ2=14.294,P=0.006),and between the younger and middle-aged group in the pairwise comparison.The most common subjective reason for visiting was slow weight gain(n=249,42.9%),followed by worrying about insufficient milk(n=142,24.4%)and feeding difficulties(n=132,22.7%).Whereas the top three practical reasons for visiting included infant's inability to latch on or sucking(n=165,28.4%),lack of breastfeeding knowledge(n=149,25.6%)and inappropriate maternal feeding skills(n=140,24.1%).The younger group faced more problems regarding latching on or sucking[39.6%(125/316]and mother's feeding skills[25.9%(82/316)],while the lack of breastfeeding knowledge mainly occurred in the older group[48.3%(42/87)].The coincidence rates between the subjective and actual reasons for slow weight gain,worrying of insufficient milk,and feeding difficulties were only 1.2%(n=3),6.3%(n=11),and 21.2%(n=28).Conclusions Breastfeeding-related problems exist in infants of different ages below one year old.There is a big knowledge gap between the subjective reasons for medical visits and the actual problems that interfere with breastfeeding.Therefore,individualized breastfeeding guidance for infants of different ages is recommended in children's health clinics.