Infant Feeding Practices Study (IFPS) II

What to know

  • The Food and Drug Administration/CDC Infant Practices Study II (IFPS II) was conducted 2005–2007.
  • Questionnaire responses provided information to study U.S. breastfeeding and infant feeding practices.
  • Questionnaires started with the third trimester of pregnancy, continuing through infant's first year of life.
  • Learn about the IFPS II questionnaires, screening, and process.
A mom hugs her young daughter.

Overview

IFPS II followed women continuously from pregnancy throughout their infants' first year of life from 2005 through 2007. During pregnancy, each woman was mailed a prenatal questionnaire. A subsample of 1,500 women received the diet history questionnaire about their own food intake and dietary supplements. The questionnaires were followed by telephone birth screener interviews around the expected dates of delivery. These were to determine whether the babies had been born.

Mother and baby dyads were followed with neonatal questionnaires mailed 2 to 4 weeks after each baby's birth. Then a series of nine postnatal questionnaires were mailed approximately monthly throughout each infant's first year of life. A subsample of 1,500 mothers received another diet history questionnaire when their infants were 4 months. This questionnaire was to assess the mother's diet. To the extent possible, the postnatal diet history questionnaires were sent to the same women who completed them prenatally.

Questionnaires and modules

Demographic questionnaires were routinely sent to consumer opinion panel (COP) members. These questionnaires asked for basic demographic data. These data included age and sex of all household members, household size, race and Hispanic ethnicity, and marital status. Additionally, data included education, employment status, occupation, household income, and home ownership.

The prenatal and postpartum diet history questionnaires collected information from a subsample of mothers. The questionnaires asked about the food that these mothers ate and their nutrients intake from foods and dietary supplements. Using a questionnaire mailed near the end of pregnancy and 4 months postpartum, this part of the study provided information on:

  • Mother's consumption of certain fortified foods.
  • Foods of concern during pregnancy and lactation.
  • Alcohol intake.
  • Prenatal vitamin supplements.
  • Herbal and botanical preparations sometimes used for conditions of pregnancy or breastfeeding.

Until the IFPS II, little was known about herbal product use among pregnant and lactating women. The non-pregnant/non-postpartum diet history questionnaire was identical to the prenatal and postpartum versions. The questionnaire was sent to a sample of 1,400 non-pregnant/non-postpartum women of child-bearing age for comparison purposes.

A prenatal questionnaire was sent to women in the third trimester of pregnancy. The questionnaire focused on factors associated with infant feeding choices, family medical history, and mother’s employment and social support system.

Birth screeners consisted of brief telephone interview with any adult household members. The goal was to determine whether infants had been born and whether families qualified to continue study participation. Families not reached by telephone were mailed postcards asking to dial into an Interactive Voice Response questionnaire. If the families did not respond to the postcard, they were mailed copies of the birth screener questions and neonatal questionnaires. The mailings were sent around the time families would have received the questionnaires if babies had been born on the due dates. To qualify, women and their infants had to meet these criteria:

  • Healthy infant and mother.
  • Full-term or near-term birth.
  • Birth weight of at least 5 pounds.
  • A single birth (no twins or multiple births).

Birth Screener: Mailer accompanying the Neonatal Questionnaire

Neonatal questionnaires were sent to mothers when their infants were approximately 3 weeks old. The questionnaires examined factors that commonly occur near the time of birth and that affect infant feeding choices. The questionnaires also asked about early feeding practices (including herbal intake by the infant), sources of information, and sources of support. Additionally, the questionnaires asked about any feeding-related treatment for jaundice.

Postnatal questionnaires consisted of various combinations of eight modules. These questionnaires were mailed to mothers approximately monthly from the time their infants were 2 months through 7 months. The questionnaires were then mailed three times (about every 7 weeks) until 12 months. Many modules included questions that were asked in some months but not others. View the timetable for when each topic was administered. Explore the information below to view the questionnaire topics and questionnaires by month.

Module A: Infant feeding and health

Module A was sent with each postnatal questionnaire. This module contained a major study measure: the infant’s food frequency checklist. The questionnaire also asked about:

  • Dietary supplement and herbal intake by infants.
  • Details about breastfeeding and infant formula feeding.
  • Infant health and medicine use.
  • Infant weight and length.
  • Stool characteristics.
  • Feeding of commercial baby foods.

In month 2 only, the questionnaire also included a postpartum depression measure.

The food frequency checklist enabled researchers to analyze patterns of breastfeeding exclusivity. In particular, the checklist allowed analysis of whether mothers occasionally gave formula to infants who were otherwise exclusively breastfed. Patterns of feeding foods other than breast milk and formula indicated the extent to which mothers followed current infant feeding guidelines.

These guidelines included those published by national professional organizations. Information on whether foods fed to infants were baby foods provided information about infant exposure to foods marketed for older children and adults. These included foods fortified at levels only appropriate for older age groups.

Module B: Breastfeeding cessation

Breastfeeding cessation questions were included on each postnatal questionnaire, but were answered only once, just after mothers had completely stopped breastfeeding. This module established the infant age when breastfeeding stopped. The module asked about reasons for breastfeeding cessation and attitudes toward breastfeeding.

Module C: Food allergy

The food allergy segment asked whether a mother believed her infant had a food allergy. The segment asked for details of the implicated food and the infant's symptoms, diagnoses, and treatments. Module C was sent when an infant was aged 4 months, 9 months, and 12 months.

Module D: Breastfeeding, pumping, and expressing milk

Module D asked for details about breastfeeding:

  • Mother’s sources of information.
  • Any maternal dietary change due to breastfeeding.
  • Mother's reasons for supplementing with formula or other foods.
  • Details of mother's experience expressing breast milk manually or with a breast pump.

Module D also included a measure of the mother’s embarrassment about breastfeeding and how she managed breastfeeding and work. This module was sent three times, at months 2, 5, and 7.

Module E: Infant formula

Module E asked for details about formula feeding:

  • Formula label use and understanding.
  • Sources of information.
  • Brand formula choice.
  • Brand formula changing.
  • Food safety practices.

Module E was sent four times, at months 2, 5, 7, and 9.

Module F: Information sources

Module F had questions not asked together but rather inserted among questions in the other modules as appropriate.

  • A question about sources of information on herbal products was sent at months 3 and 10.
  • Questions about information sources for breastfeeding were sent in month 2.
  • Questions about information sources for general infant feeding were sent in months 4 and 10.

Module G: Breastfeeding awareness campaign evaluation

Module G included direct measures of a mother's awareness of the National Breastfeeding Awareness Campaign messages. The module asked whether a mother agreed with those messages. Like Module F questions, Module G questions were not asked as a separate module and were incorporated appropriately in other modules. Questions from Module G were sent in months 3 and 7.

Module H: Sleeping arrangements, child care, employment, and health

Module H asked about all topics other than feeding. These included:

  • Sleeping arrangements and position.
  • Child care and child care support for breastfeeding
  • Mother’s employment and employer support for breastfeeding.
  • Mother's management of combining breastfeeding and work for pay.
  • Mother’s overall health, weight status, and tobacco use.

Module H was sent in months 3, 6, 9, and 12. A question about exposure to sunlight was administered when infants were 9 months.

Module J: Other information

Women, Infants, and Children (WIC) participation and infant health problems were asked about at the end of each postnatal questionnaire. The presence of a severe health condition disqualified an infant from participating in the rest of the study. Certain questions from other modules that did not fit elsewhere were also included in Module J in months those modules were administered.

Section A asked about:

  • Child care and characteristics including who cares for the child when not in school and where the child care occurs.
  • Type of school and grade.
  • Provision of an individualized education program or any special developmental services.
  • Cognitive stimulation at home.
  • Strengths and limitations questionnaire.

Section B documented information related to the child's current health status. The section also includes questions that document the child's weight and height measurements. The mother was sent a tape measure and instructions on measuring the child's height and was asked to report the measurement. She was also asked to weigh the child on a scale and report the weight. Additionally, the mother was asked to report the last height and weight measurement from a doctor's office and the date.

Section B continued with questions about the mother's perceptions of her child's:

  • Weight.
  • Dental care.
  • Health.
  • Use of herbal or botanical remedies.

This section also included detailed questions about breathing difficulties and food allergy. Herbal or botanical remedies use was included in this health section rather than in the dietary intake section. This was to measure use of supplements as medicines rather than as beverages (for example, herbal tea consumed as a beverage).

Section C asked about the child's level of physical activity, screen time, and sleeping characteristics.

Section D began with questions about exposure to pets and inhaled contaminants other than cigarette smoke. These inhaled contaminants included air fresheners, scented candles, and pesticides.

The remainder of the section was about the child's eating patterns:

  • Dietary intake measured by a food frequency questionnaire.
  • Food environment, such as the availability of healthful snacks.
  • Parent control of the child's diet and eating.

Section E focused on the mother and family. The section included:

  • Family medical history and mother's anthropometry.
  • Cigarette smoking by the mother and in the home.
  • Mother's physical activity level.
  • A depression scale for the mother.
  • Pregnancy and child feeding history.
  • Parental employment and insurance coverage for the child.
  • Receipt of government benefits (including WIC participation for the aged 6 child and any children born after that aged 6 child).
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Content Source:
National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP)