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嬰兒餵食方式對嬰兒生長及行為發展之影響:台灣出生世代之研究嬰兒餵食方式對嬰兒生長及行為發展之影響:台灣出生世代之研究 • 本研究的目的在探討嬰兒餵食方式對嬰兒生長及行為發展之影響。嬰兒餵食方式包括餵食母乳及添加副食品。餵食母乳的時間依照餵食母乳時間的不同分成：完全餵食配方奶(簡稱沒餵過母乳)、 持續餵食母乳的時間不到六個月(簡稱餵食母乳時間較短)及持續餵食母乳的時間至少六個月(簡稱餵食母乳時間較久)三組。依照開始添加副食品時間點不同分成：在六個月之前添加副食品(簡稱較早添加副食品)以及在六個月之後添加副食品(簡稱較晚添加副食品)。依照上述分組探討不同嬰兒餵食方式對嬰兒體重、身高、動作發展、語言溝通及社會能力等之影響。本研究的資料來源為「台灣出生世代研究(Taiwan Birth Cohort Study,簡稱TBCS) 」中在嬰兒六個月及十八個月時收集的資料，包括餵食母乳時間、副食品添加時間、出生至十八個月的生長發育、行為發展評估及部分家庭背景資料。台灣出生世代之研究以分層分階段隨機抽樣的方法，將2005年出生之嬰兒抽出24,200人作為研究樣本。本研究排除先天性缺陷、出生後有住過院，選擇出生週數在37至41週的嬰兒，作為本研究的研究對象，共有15,868人。以獨立性t檢定、變異數分析、線性迴歸及廣義估計式等統計方法分析餵母乳時間長短、副食品添加早晚及其他相關因素對嬰兒生長發育及行為發展之影響。在控制干擾因子後，就體重發展而言：餵食母乳時間較久的嬰兒，其體重從七個月後開始顯著比餵食母乳時間較短與沒餵過母乳的嬰兒輕。七至十二個月時，餵食母乳時間較久的嬰兒比餵食母乳時間較短輕198公克；餵食母乳時間較久的嬰兒比沒餵過母乳的嬰兒輕192公克。在十三至十八個月時，餵食母乳時間較久的嬰兒比餵食母乳時間較短輕204公克； 餵食母乳時間較久的嬰兒比沒餵過母乳的嬰兒輕203公克。副食品添加時間早晚對嬰兒體重沒有顯著影響。在身高發展方面，在控制干擾因子後，餵食母乳時間較久的嬰兒，其身高在出生後開始顯著比餵食母乳時間較短的嬰兒稍矮。在出生後至六個月期間，餵食母乳時間較久的嬰兒平均比餵食母乳時間較短的嬰兒矮0.13公分。在七至十二個月期間，餵食母乳時間較久的嬰兒平均比餵食母乳時間較短的嬰兒矮0.50公分。在十三至十八個月期間，餵食母乳時間較久的嬰兒平均比餵食母乳時間較短的嬰兒矮0.44公分。餵食母乳時間較久組，在七個月後開始比沒餵過母乳組稍矮。在七至十二個月期間，餵食母乳時間較久的嬰兒平均比沒餵過母乳的嬰兒矮0.51公分。在十三至十八個月期間，餵食母乳時間較久的嬰兒平均比沒餵過母乳的嬰兒矮0.33公分。較晚開始添加副食品的嬰兒，其身高只有在七至十二個月期間才比較晚添加的嬰兒稍矮(平均約矮0.24公分)。嬰兒行為發展方面，在控制干擾因子後，餵食母乳時間較久的嬰兒(平均分數為11.01±0.03分)，粗動作發展顯著比沒餵過母乳的嬰兒(10.91±0.03分)稍佳(P<0.05)。嬰兒喝母奶的時間愈長，嬰兒細動作、語言溝通及社會能力發展顯著愈佳(P<0.001)。餵食母乳時間較久的嬰兒，其粗動作、細動作、語言溝通及社會能力發展的成績依序為10.98±0.03、10.22±0.04及13.31±0.04分；餵食母乳時間較短的嬰兒，其粗動作、細動作、語言溝通及社會能力發展的成績依序為10.85±0.02、10.07±0.04及13.16±0.03分；沒餵過母乳的嬰兒：其粗動作、細動作、語言溝通及社會能力發展的成績依序為10.74±0.03、9.85±0.05及13.04±0.04分。較早添加副食品的嬰兒，在各方面行為發展均比晚添加副食品的嬰兒為佳。較早添加副食品的嬰兒，其粗動作、細動作、語言溝通及社會能力發展的成績依序為11.03、10.96、10.16及13.29分；較晚添加副食品的嬰兒，其粗動作、細動作、語言溝通及社會能力發展的成績依序為10.90、10.76、9.93及13.05分。排除六個月行為發展較佳的嬰兒後，結果顯示副食品添加時間的早晚對嬰兒的粗動作、語言溝通及社會能力發展沒有顯著影響，但較早添加副食品的嬰兒，其細動作的發展仍顯著稍微較佳(P<0.05)。較早添加副食品的嬰兒，其細動作成績為10.81分；較晚添加副食品的嬰兒，其細動作成績為10.68分。綜合上述結果顯示，餵食母乳時間超過六個月的嬰兒，其體重較輕、身高稍矮，但行為發展的表現較佳。副食品添加時間對嬰兒體重及行為發展無顯著影響，但是較早添加副食品的嬰兒，其身高稍微比較晚添加的嬰兒高一些。
The Effects of Infant Feeding Patterns on Growth and Behavioral Development：Results from the Taiwan Birth Cohort Study • This study explored the effects of infant feeding patterns─ included of breastfeeding duration and complementary feeding time─on growth and behavioral development. Breastfeeding duration categorized as “only formula feeding (no breastfeeding)”, “less than six months (short breastfeeding duration) ” and “over six months (long breastfeeding duration) ”. Complementary feeding time categorized as “before six months (earlier feeding) ” and “ by 6 months (later feeding) ” The impact of different feeding patterns on infant weight, height, gross motor, fine motor, language and social skills was examined.This study was based on questionnaire interviews as part of the Taiwan Birth Cohort Study, which collected information on infants aged six and 18 months covering breastfeeding duration, infant growth, behavioral development scale (gross motor, fine motor, language and social skills) and some confounding factors.Research subjects were selected from Taiwan birth registration data for 2005 using multi-stage stratified random sampling. The sample population, based on gestational ages between 37 to 41 weeks, was 15,868 infants after excluding those with birth defects or hospitalized after birth. Independent-sample t test, analysis of variance, general linear models and generalized estimating equations were used to analyze the effects of infant feeding patterns and other related factors on infant growth and behavioral development.As regards growth development, the weight and height of infants aged 18 months, was found to be significantly lower for the long breastfeeding duration group compared with the short breastfeeding duration or no breastfeeding categories after adjusted for confounding factors. (weight:102 and 85 g lighter, respectively, height: 0.25 and 0.22 cm shorter, respectively); The age at which the weight of infants under the long breastfeeding duration category dropped below those infants in the short breastfeeding duration or no breastfeeding categories was seven months. The age at which the height of infants under the long breastfeeding duration category dropped below that infants in the short breastfeeding duration or no breastfeeding categories was after birth and seven months slightly, respectively. Following results for adjusted for all confounding factors: The effects of complementary feeding time on infant weight didn’t have significant difference. The height of infants aged 18 months, was found to be significantly lower for the later feeding group compared with the earlier feeding group slightly. (About 0.12 cm shorter) The age at which the height of infants under the later complementary feeding category dropped below that infants in the earlier complementary feeding group was only during seven to twelve months slightly(About 0.24 cm shorter).As regards behavioral development after controlled confounding factors, infants in the long breastfeeding duration categories (11.01±0.03 scores) were found to have significantly better gross motor skills than infants that had not been breastfed (10.91±0.03 scores) (P<0.05). As for fine motor, language and social skills, infants in the longer breastfeeding duration category performed best(10.98±0.03, 0.22±0.04 and 13.31±0.04 scores , respectively), followed by the shorter breastfeeding duration(10.85±0.02, 10.07±0.04 and 13.16±0.03 scores, respectively) and no breastfeeding categories(10.74±0.03, 9.85±0.05 and 13.04±0.04 scores, respectively) (P<0.001). As for all behavioral development, infants in the earlier complementary feeding category performed better slightly. When we excluded of infants who got fast behavioral development of six months, the impacts of complementary feeding time became no significant difference on infant behavioral development of gross motor, language and social skills. But earlier complementary feeding still had better development of fine motor slightly(earlier feeding and later feeding: 10.81 and 10.68 scores, respectively) (P<0.05). Overall, the results found that although the weight and height for infants in the long breastfeeding duration category was significantly lower than other feeding groups, they outperformed the others in terms of their behavioral development. The impacts of complementary feeding time had no significant difference on infant weight and behavioral development. The height for infants in the later complementary feeding category was significantly lower than earlier complementary feeding category.
