Pediatrics

Exclusive Breast-feeding: Is Motivation

the Only Issue?
M Girish*, N Mujawar**, V Dandge**, P Pazare†, K Gaikwad‡

Abstract
Objectives: The aim of the study was: (1) To know the frequency of suboptimal infant breastfeeding behavior (SIBB), delayed
onset of lactation (DOL) and excess neonatal weight loss (EWL) in mother-infant pairs with a high motivation to breastfeed;
(2) to see if SIBB influenced lactational problems represented by: a] DOL, b] EWL; (3) in addition, we have tried to assess the risk
factors for SIBB and other risk factors for DOL and EWL. Material and methods: A longitudinal hospital-based observational
study. Infant breastfeeding behavior was assessed by IBFAT score, DOL was measured by maternal perception of breast
fullness and maternal motivation by an initial interview based on breastfeeding self-efficacy scale. Results: Frequency of SIBB
was 13.3% on Day 0, 6.6% on Day 3 and 2.9% on Day 7. DOL occurred in 11.8% of mothers and excess weight loss in 17.7% of
infants. Prolonged labor, medications given during labor, inadequacy of sleep during peripartum and use of supplementary
feeds were found to be significantly associated with SIBB. Infants with SIBB on Day 0 were 17 times more likely to have SIBB on
Day 3 and they were also four times more likely to have excess weight loss. Failure of exclusive breastfeeding (EBF) occurred
in 8.1% and showed a significant association with SIBB, but at two weeks all were breastfeeding exclusively. Conclusion:
Infant behavior plays an important role in the success of early breastfeeding and if suboptimal, contributes to failure of EBF.
Both infant behavior and onset of lactation constitute significant predictors of excessive weight loss and short-term failure of
exclusive breastfeeding and help in determining the need for intensive lactation counseling in high-risk cases.
Keywords: Suboptimal infant breastfeeding behavior, exclusive breastfeeding, neonatal weight loss, onset
of lactation

T
he mother-baby symbiotic dyad can be Studies investigating failure of EBF3,4 have put
considered to last for 15 months, connected by the spotlight on the mother or the environmental
the umbilical cord for the first nine months and influences acting on the mother (lack of support
by breastfeeding for the next six months. The infant’s for breastfeeding by social workers and healthcare
health is imperiled not just if the first period of nine providers, emotional stress in mothers and their
months is shortened but also if the second period perception of not having enough breast milk, and
is pruned. Exclusive breastfeeding (EBF) remains pressure from close relatives to introduce other
uncommon in most countries (both developed and liquid foods, unsupportive hospital practices that
developing), even in countries with high rates of delay early initiation of breastfeeding and maternal
breastfeeding initiation.1,2 employment). While psychosocial and cultural
barriers are reported as important contributing
factors, there have been instances where mothers were
highly motivated to breastfeed but were discouraged
within the first few weeks due to insufficient milk
and suboptimal breastfeeding behaviors among
*Associate Professor newborns leading to excessive weight loss and other
**Professor
medical complications, even death.5,9
†Lecturer
‡Assistant Lecturer Based on the hypothesis that even highly motivated
Dept. of Pediatrics mothers can face problems in breastfeeding including
NKP Salve Institute of Medical Sciences and Research Center
Nagpur, Maharashtra problems with infant behavior we decided to study
Address for correspondence the phenomenon of suboptimal infant breastfeeding
Dr Kiran Gaikwad
28, Karim Layout, Gopal Nagar, Nagpur, Maharashtra - 440 022
behavior (SIBB) and other lactation problems in this
E-mail: ksgaikwad@hotmail.com group of mothers.

Indian Journal of Clinical Practice, Vol. 24, No. 3, August 2013 271
Pediatrics
aims and objectives
The aim of the study was: (1) To know the frequency
of SIBB, delayed onset of lactation (DOL) and excess
neonatal weight loss (EWL) in mother-infant pairs
with a high motivation to breastfeed; (2) to see if
SIBB influenced lactational problems represented by:
a) DOL, b) EWL; (3) in addition, we have tried to assess
the risk factors for SIBB and other risk factors for DOL
and EWL.
Material and Methods
This observational longitudinal study was conducted
in a tertiary care hospital in Nagpur, Maharashtra
after taking approval from the Institutional Ethics
Committee. A pilot study was done and the prevalence
of SIBB was found to be 11%. In the absence of Indian
data, 11% prevalence at 95% confidence interval (CI)
and 80% power was considered to calculate the sample
size. All mothers who delivered their babies during
the period between April and September 2009, were
interviewed and included if: (1) They delivered term
appropriate for age babies with no perinatal morbidities;
(2) they were motivated to breastfeeding exclusively
(based on a shortened version of the breastfeeding self-
efficacy scale) and (3) they resided near the hospital
area and were willing to participate in the study.
Infant’s behavior was assessed using the Infant
Breastfeeding Assessment Tool (IBFAT), which
includes ratings for arousal, rooting, time to latch
and feed well, sucking effectiveness. Each point is
worth 0-3 with a total maximum score of 12. A score
of <10 was considered SIBB. Onset of lactation (OL)
was determined by maternal report of breast fullness
changes; DOL was defined as breast fullness perceived
after 72 hours. EWL was defined as loss of weight ≥10%
of birthweight by Day 3.
At the time of delivery, information was collected
from the medical record concerning the duration of
Stage I and II labor (from onset of regular contractions
to cervical dilation of 10 cm and from full dilation
to the delivery of the infant, respectively), mode
of delivery, labor medications, infant resuscitation,
gravida, parity and infant birth weight. Breastfeeding
guidance was given by the first author within 24 hours
of delivery and then at every opportunity, emphasizing
correct positioning and latching on to the breast and
the importance of demand feeding and avoidance of
supplements.
272 Indian Journal of Clinical Practice, Vol. 24, No. 3, August 2013
The mother was interviewed for following information:
ÂÂ The interval without sleep before delivery.
ÂÂ Infant feeding pattern since birth (when first put
to breast since the time of birth; infant interest
in nursing in the form of smacking or licking
lips, opening and closing mouth, sucking on lips,
tongue, hands, fingers, increased alertness
and movements of arms and legs, number of
breastfeeds; use of supplemental fluids/feeds).
ÂÂ Family support during delivery.
ÂÂ Previous experience of breastfeeding.
ÂÂ Her confidence in her ability to exclusively
breastfeed her infant for six months (on a scale of
1 = no confidence, to 5 = very confident).
Breastfeeding observation was done by a research
assistant who worked exclusively on this project for
six months. Data regarding nipple type (flat/inverted/
normal), maternal and infant positioning, suckling
behavior and mother’s report of pain during feeding
was recorded.
IBFAT score was recorded on Days 0, 3, 7 (counting
the day of birth as 0) and lactation guidance was
continued. The guidance provided was as per the
ILCA (International Lactation Consultant Association)
guidelines.
On Day 3 additional information collected were: a)
Frequency of feeding; b) level of breast fullness (on a
scale of 1-5; with 1 = no change and 5 = uncomfortably
full); c) the approximate time postpartum when breast
fullness first reached 3; d) supplemental feeds given;
e) the level of support received from other family
members (1 = most not supportive, 2 = some supportive,
3 = a lot of support) and f) any pain or discomfort
encountered during feeding. Infant’s weight was taken
on an electronic weighing scale.
Any baby who had excess weight loss was given
appropriate management (either close observation or
neonatal intensive care unit [NICU] admission). Maternal
body mass index (BMI) was measured on Day 14.
Statistical Analysis
Bivariate associations between five outcome variables,
namely, SIBB on Days 0, 3, 7, DOL, excessive weight
loss and 13 independent variables were examined using
χ2 tests or Fisher’s test. Multiple logistic regression
analysis was used to control for associations among the
independent variables. Stepwise selection was used to
construct the preliminary models (p level for inclusion
or removal = 0.05). The independent variables for each

preliminary model were chosen based on whether: a)
There was a theoretical basis for an association between
the independent variable and the outcome; b) the
independent variable preceded the outcome variable
in occurrence, potential interaction with parity and
mode of delivery were examined, wherever there was
a significant outcome for a given independent variable
in the bivariate analyses.
In preliminary analyses, potential interactions with
parity and delivery mode were also examined, but
these were not included in the regression models
because there was little evidence that the association
of the outcomes with any of the independent variables
differed in mothers with vaginal versus cesarean
section delivery or in primipara versus multipara.
Bivariate associations among the five outcome variables
were also examined.
Results
One hundred thirty-five mother-infant pairs were
included for the final analysis. Attitude towards
breastfeeding were strongly positive with 84.4%
mothers confident about breastfeeding exclusively
for six months and 93.3% reporting full family
support for same. About 8.1% babies received
supplementation in the form of cow’s milk, water or
glucose supplementation.
The mean maternal age was 22.4 years and 50% were
primiparous. Majority of mothers were educated upto
middle school (63.7%). About 32.2% mothers underwent
cesarean section, 80% of which was performed on
primipara. The duration of labor was longer in
primipara, analgesics during labor were given to only
14% and 12.5% received oxytocin, all in primipara.
Early breastfeeding (within half an hour after normal
delivery and 4 hours after cesarean section) was
influenced more by the mode of delivery (delayed
in 36% of cesarean) than by the parity. Average
breastfeeding frequency was 8 ± 2 on Day 0.
Frequency of SIBB was 13.3% on Day 0, 6.6% on Day
3 and 2.9% on Day 7. SIBB was significantly associated
with prolonged labor (SIBB Day  0), medications
given during labor especially oxytocin and maternal
analgesics (SIBB Day 0), inadequacy of sleep in the
mother during the peripartum period (SIBB Days 0
and 3), use of supplementary feeds (SIBB Days 3
and 7). DOL occurred in 11.8% of mothers. There was
significant association with the use of supplementary
feeds in the babies and the type of family (nuclear/joint).
Excess weight loss occurred in 23.7% of infants and was
Pediatrics
also significantly associated with use of supplementary
feeds and type of family (more common in nuclear
family).
Infants with SIBB on Day 0 were 17 times more likely
to have SIBB on Day 3 (p < 0.002, lower CL 2.6 and
upper CL 125.7, Fisher exact test) and they were also
nearly four times more likely to have excess weight
loss. No significant association was found between
SIBB on Day 0 and SIBB on Day 7 as well as DOL in the
mother. At two weeks, all the babies were on exclusive
breastfeeding.
Discussion
The results indicate that lactation difficulties are not
uncommon during first few days postpartum even
among mothers who were highly motivated to breast-
feed exclusively, though the incidence of SIBB reported
in our study (13.3% on Day 0, 6.6% on Day 3 and
2.9% on Day 7) population is much lower than that
observed in a similar study done in California, USA.10
But, the incidence of excess weight loss is much higher
in our study (21.7%) as compared to western data.11
Significant association between SIBB on Day 0 and the
risk of excess weight loss and SIBB on Days 3 and  7
with the use of supplementary feeds indicates that
infant breastfeeding behavior assessment would help
in identifying babies at high-risk for breastfeeding
complications. In our study, all the babies with a
low SIBB score were given repeated and intensive
lactation counseling and this may explain the fact
that the incidence of SIBB decreased progressively
by Day 7, SIBB on Day 0 improved and weight gain
occurred by Day 7 and more importantly, the fact that
all the mothers were giving exclusive breastfeeding at
two weeks. DOL occurred in 11.8% but we found no
significant association with suboptimal infant behavior
either on Day 0 or Day 3. DOL was significantly
associated with the use of supplementary feeds in the
first 48 hours and this finding has been corroborated
by several other studies.12-15 The vicious cycle of
supplementary feeding and lactational problems have
been highlighted and emphasized in the past. Early
supplementary feeds lead to DOL resulting in further
supplementation thereby perpetuating the cycle.
This may also prime future decisions to supplement,
leading to an earlier introduction of top feeds. Exclusive
breastfeeding indicates that the baby will receive only
breast milk and no prelacteals or supplementary feeds
with the exception of drops or syrups consisting of
vitamins, mineral supplements or medicines.16 By this
definition, all the babies who received supplementary
Indian Journal of Clinical Practice, Vol. 24, No. 3, August 2013 273
Pediatrics
feeds in our study (8.1%) represent failure of exclusive
breastfeeding and towards this end, both SIBB (on
Days 0 and 3) and DOL contributed towards temporary
failure in exclusive breastfeeding but the trend was
reversed successfully through timely intervention.
There have been conflicting reports on association of
labor medications and infant suckling behavior.17-20
We studied induction of labor with oxytocin and
IV analgesics during labor and found that they
significantly affected breastfeeding behavior on first
day of life. Two other factors found to be associated
with a greater risk of SIBB on Day 0 were prolonged
labor (total duration >12 hours) and adequacy of
sleep before labor pains in the mother. We presume
that the longer duration of labor and inadequate
sleep could increase stress in the mother during the
postpartum period and this may affect mother infant
bonding. These findings imply that modification of the
labor and delivery experience should improve early
lactation success, a recommendation often made in
various studies.21-23 The role of joint family system on
the success of exclusive breastfeeding is controversial.
While administration of prelacteals and supplementary
feeds is usually attributed to family pressures in a
joint family system, we found that supplementary feeds
were more often used and delayed lactation occurred
more commonly in mothers belonging to nuclear
families thus reinforcing the need for the traditional
joint family system; of course lactation guidance should
be given to the entire family!
Conclusion
In the list of factors conducive for exclusive
breastfeeding in healthy neonates the thrust so far
has been on maternal factors. In this study, we have
tried to turn the spotlight also on infant behavior
as an important variable, which deserves attention.
Infant behavior plays an important role in the
success of early breastfeeding and if suboptimal,
contributes to failure of EBF. Evaluation of infant
breastfeeding behavior as well as onset of lactation
in the early days could predict excessive weight
loss and possibility of supplementary feeding in the
neonate. Suboptimal infant breastfeeding behavior
is amenable to intervention (lactation management
counseling, avoidance of supplementary feeds,
modifications in use of labor medications).
All women with breastfeeding problems initially
can eventually establish an adequate milk supply
but the phenomenon should be taken seriously and
every opportunity should be taken to address all the
274 Indian Journal of Clinical Practice, Vol. 24, No. 3, August 2013
issues responsible for this including infant behavior,
not only because it can lead to poor breastfeeding
outcome in the short-term but it is known to lead to
shorter duration of exclusive breastfeeding.7
References
1. Dimond HJ, Ashworth A. Infant feeding practices in
Kenya, Mexico and Malaysia. The rarity of the exclusively
breast-fed infant. Hum Nutr Appl Nutr 1987;41(1):51-64.
2. Perez-Escamilla R. Breastfeeding in Africa and the Latin
American and Caribbean region: the potential role of
urbanization. J Trop Pediatr 1994;40(3):137-43.
3. Froozani MD, Permehzadeh K, Motlagh AR, Golestan B.
Effect of breastfeeding education on the feeding pattern
and health of infants in their first 4 months in the Islamic
Republic of Iran. Bull World Health Organ 1999;77(5):381-5.
4. Imdad A, Yakoob MY, Bhutta ZA. Effect of breastfeeding
promotion interventions on breastfeeding rates, with
special focus on developing countries. BMC Public Health
2011;11 Suppl 3:S24.
5. Banapurmath CR, Nagaraj MC, Banapurmath S, Kesaree
N. Breastfeeding practices in villages of central Karnataka.
Indian Pediatr 1996;33(6):477-9.
6. Hall RT, Mercer AM, Teasley SL, McPherson DM, Simon
SD, Santos SR, et al. A breast-feeding assessment score to
evaluate the risk for cessation of breast-feeding by 7 to 10
days of age. J Pediatr 2002;141(5):659-64.
7. McLeod D, Pullon S, Cookson T. Factors influencing
continuation of breastfeeding in a cohort of women.
J Hum Lact 2002;18(4):335-43.
8. Mathur GP, Chitranshi S, Mathur S, Singh SB, Bhalla M.
Lactation failure. Indian Pediatr 1992;29(12):1541-4.
9. Neifert MR. Prevention of breastfeeding tragedies. In:
The Pediatric Clinics of North America, Breastfeeding
2001, Part II: The Management of Breastfeeding. Volume
48. Schanler RJ (Ed.), WB Saunders: Philadelphia, PA
2001:p.273-98.
10. Chapman DJ, Pérez-Escamilla R. Identification of risk
factors for delayed onset of lactation. J Am Diet Assoc
1999 ;99(4):450-4; quiz 455-6.
11. Dewey KG, Nommsen-Rivers LA, Heinig MJ, Cohen RJ.
Risk factors for suboptimal infant breastfeeding behavior,
delayed onset of lactation, and excess neonatal weight
loss. Pediatrics 2003;112(3 Pt 1):607-19.
12. Manganaro R, Mamì C, Marrone T, Marseglia L, Gemelli
M. Incidence of dehydration and hypernatremia in
exclusively breast-fed infants. J Pediatr 2001;139(5):673-5.
13. Ransjö-Arvidson AB, Matthiesen AS, Lilja G, Nissen E,
Widström AM, Uvnäs-Moberg K. Maternal analgesia
during labor disturbs newborn behavior: effects on
breastfeeding, temperature, and crying. Birth 2001;
28(1):5-12.
 Pediatrics

14. Kramer MS, Barr RG, Dagenais S, Yang H, Jones P, Ciofani
L, et al. Pacifier use, early weaning, and cry/fuss behavior:
a randomized controlled trial. JAMA 2001;286(3):322-6.
15. ABM Clinical Protocol #3. Hospital Guidelines for the Use
of Supplementary Feedings in the Healthy Term Breastfed
Neonate, Revised 2009. The Academy of Breast Feeding
Medicine Protocol Committee. Breast Feeding Medicine
2009:4(3):175-82.
16. WHO Geneva. Indicators for assessing breastfeeding
practices. WHO Geneva Switzerland: WHO Document
WHO/CDD/SER1991;9:14.
17. Crowell MK, Hill PD, Humenick SS. Relationship between
obstetric analgesia and time of effective breast feeding.
J Nurse Midwifery 1994;39(3):150-6.
18. Riordan J, Gross A, Angeron J, Krumwiede B, Melin J. The
effect of labor pain relief medication on neonatal suckling
and breastfeeding duration. J Hum Lact 2000;16(1):7-12.
19. MacMullen NJ, Dulski LA. Factors related to sucking
ability in healthy newborns. J Obstet Gynecol Neonatal
Nurs 2000;29(4):390-6.
20. Halpern SH, Levine T, Wilson DB, MacDonell J, Katsiris
SE, Leighton BL. Effect of labor analgesia on breastfeeding
success. Birth 1999;26(2):83-8.
21. Radzyminski S. The effect of ultra low dose epidural
analgesia on newborn breastfeeding behaviors. J Obstet
Gynecol Neonatal Nurs 2003;32(3):322-31.
22. Ounsted MK, Hendrick AM, Mutch LM, Calder AA,
Good FJ. Induction of labour by different methods in
primiparous women. I Some perinatal and postnatal
problems. Early Hum Dev 1978;2(3):227-39.
23. Zuppa AA, Vignetti M, Romagnoli C, Tortorolo G.
Assistance procedures in the perinatal period that
condition breast feeding at the time of discharge from the
hospital. Pediatr Med Chir 1984;6(3):367-72.

Nearly half of parents who visited the emergency department with a child who had suffered a head injury knew
that computed tomography (CT) imaging was associated with an increased lifetime cancer risk, and 90.7% of
parents wanted to know about such risk potential before CT use, according to a prospective cross-sectional study.
(Source: Medscape)
Close to half of 2-month-old have “positional plagiocephaly” - a flat spot on the back of their heads - and changes
in parents’ habits may be a cause. Although not thought to be medically dangerous, the flattened head shape
can become permanent, which can have psychological implications for kids as they grow up, Canadian authors
suggest. (Source: Medscape)
Newborn screening for critical congenital heart disease (CCHD) in the United States could be reasonably cost-
effective, according to the first US cost-effectiveness analysis of such screening, published online August 5 in
Pediatrics. According to Cora Peterson, PhD, from the National Center on Birth Defects and Developmental
Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues, clinical evidence
indicates newborn (CCHD) screening through pulse oximetry is lifesaving. In 2011, CCHD was added to the US
Recommended Uniform Screening Panel for newborns. (Source: Medscape)
For newborn babies, taking ethnicity into account may help determine how small is too small. Canadian
researchers have found that birth-weight standards based on population averages did not predict which babies
born at or near term were likely to suffer problems associated with being small for gestational age. Gillian Hanley
of the School of Population and Public Health at the University of British Columbia in Vancouver said that based
on her results, adjusting the standards may be necessary. (Source: Medscape)
Providers often prescribe antibiotics for outpatient pediatric urinary tract infections (UTIs) without obtaining
urine tests according to a new study published online August 5th in the journal Pediatrics. According to Dr.
Hillary L. Copp from University of California, San Francisco, children presenting with UTI symptoms that are
treated for a UTI with and without urine testing should be prospectively evaluate to determine the implications
of these different treatment approaches. (Source: Medscape)

Indian Journal of Clinical Practice, Vol. 24, No. 3, August 2013 275
PEDIATRICS

Vitamin E Level in Normal Indian Children

Geeta Gathwala, Subrika Yadav, Ojawanai, G Lal

Abstract
Objective/Background: The study was conducted a aim to determine vitamin E levels in normal Indian children. Vitamin
E has positive effect on cardiovascular health through its ability to influence signaling process in platelets and also has
significant role in neurodegenerative disorders. Vitamin C and vitamin E supplementation retards the progression of coronary
arteriosclerosis during early stage following cardiac transplantation. It also mediates the generation and availability of
superoxide and nitric oxide and is beneficial in preventing prostate cancer or delaying disease progression. Material and
methods: Study included 30 healthy children of either sex, they were divided into three groups each of 10 children i.e.,
Group I (2-4 years) mean age 3.42 years, Group II (4-6 years) mean age 5.35 years and Group III (6-10 years) mean age 8 years.
Vitamin E levels were measured in their serum fluorometric micro methods for serum tocopherol as described by Hansen
and Warwick. Result: In Group I, the mean ± SEM value of vitamin E was 2.74 ± 1.10 µgm/ml, in Group II it was 2.82 ± 1.11
µgm/ml and in Group III it was 2.93 ± 1.12 µgm/ml. Conclusion: Serum vitamin E levels in healthy Indian children is 2.82
± 1.11µg/ml and there is no sex predilection.
Keywords: Vitamin E, healthy Indian children

V
itamin E was discovered by Even and Bishop.
Vitamin E is indispensable for reproduction
and prevents diseases associated with
oxidative stress, such as cardiovascular disease,
cancer, chronic inflammation and neurologic
disorders.1-3 Vitamin E and ω-3 fatty acids are positive
effectors of cardiovascular health through their ability
to influence signaling process in platelets. Vitamin E
has significant role in neurodegenerative disorders.4,5
Vitamin C and vitamin E supplementation retards
progression of coronary arteriosclerosis during
early stage following cardiac transplantation.6-8
Vitamin E may mediate the generation and availability
of superoxide and nitric oxide.9 Vitamin E may be
beneficial in preventing prostate cancer or delaying
disease progression.10 At transcriptional level, several
genes (CD36, tocopherol transfer protein [a-TTP],
a-topomyosin and collagenase) are modulated by
Dept. of Pediatrics Biochemistry
Pt. BD Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana
Maulana Azad Medical College, New Delhi
Address for correspondence
Dr Geeta Gathwala
Professor and Head,
Dept. of Pediatrics
6J/8, Postgraduate Institute of Medical Sciences, Rohtak
E-mail: g_gathwala@hotmail.com
a-tocopherol. These effects result in inhabitation
of smooth muscle cell proliferation, platelet
aggregation and monocyte adhesion and thus protect
atherosclerosis.11
Vitamin E has an additional positive effect on
autoimmune disease by decreasing proinflammatory
cytokines, lipid mediators and has important role in
rheumatoid arthritis patients.12 Prolonged vitamin
E deficiency leads to peripheral neuropathy, muscle
weakness and ophthalmoplegia, which are irreversible.
Fifty to 70% of children with chronic cholestasis are
vitamin E deficient, even when consuming standard
supplements of vitamin E.7 a-tocopherol is the most
bioactive form of vitamin E followed in order by
b, g and d tocopherol. The most commonly used
pharmacologic form of a-tocopherol is a totally
synthetic product and has both D and L stereoisomers
now designated as racemic a-tocopherol. This synthetic
form has considerably less bioactivity (approximately
75%) than the pure naturally occurring form. Vitamin
E is absorbed into intestinal mucosa by nonsaturable,
noncarrier-mediated passive diffusion process and
absorption is maximal in median small intestine and
none is absorbed in large intestine. Human body
stores 40 mg/kg vitamin E, 77% of which is in adipose
tissue, 20% in muscle and only 1% in liver. Since, there
is paucity of Indian data, the study was planned to
assess the serum vitamin E levels in normal Indian
children.

276 Indian Journal of Clinical Practice, Vol. 24, No. 3, August 2013

MATERIAL AND METHODS
This study was conducted in 30 healthy children
of either sex, whowere divided into three groups
each of 10 children i.e., Group I (2-4 years) mean
age 3.42 years, Group II (4-6 years) mean age 5.35
years and Group III (6-10 years) mean age eight
years. Vitamin E levels were measured in their serum
by fluorometric micro method for serum tocopherol as
described by Hansen and Warwick.13
RESULT
In Group I, the mean ± SEM (standard error of mean)
value of vitamin E was 2.74 ± 1.10 ± µg/ml, in Group II
it was 2.82 ± 1.11 ± µg/ml while in Group III it was 2.93
±1.12 ± µg/ml. (Table 1) On inter group comparison,
using students t test the difference in values amongst
the three groups was found to be nonsignificant.
Since, there was no significant difference in serum
vitamin E levels in different age groups of children
and there no specific gender predilection, we assumed
the 60 children belonging to one group to report the
serum vitamin E level in normal Indian children to be
2.82 ± 1.11µg/ml.
DISCUSSION
Among the nutritional factors contributing to maintain
health during aging, fat-soluble vitamins are crucial
to protect against free radical generated degenerative
processes or impaired efficiency of immune system.14,15
Antioxidant activity is provided by a number of
naturally occurring substances including a-tocopherol
(vitamin E) and b-carotene, whose effects are mediated
by their capacity to quench ringlet oxygen, scavenge
free radicals and prevent the formation of free radicals
and is used to prevent ultraviolet-induced skin
damage.16,17 Inadequate, intake of several vitamins
is linked to chronic diseases, including coronary
heart disease, cancer and osteoporosis.18 Enterally,
fed premature infants are supplemented fat soluble
vitamins.19 The normal serum vitamin E levels in
Table 1 Effect of Age on Vitamin E levels
Group Age Mean Vitamin P
(years) Age (Mean ± SEM) value
(years)
I 2-4 3.42 2.74 ± 1.10 NS
II 4-6 5.35 2.82 ± 1.11 NS
III 6-10 8.00 2.93 ± 1.12 NS
Pediatrics
children and adults range from 5 to 20 µg/ml and
are slightly lower in infants and young children i,e,
3-10µgm/ ml. In our study also, vitamin E levels were
found to increase with age i.e., (mean ± SEM was
2.74 ± 1.10, 2.82 ± 1.11, 2.93 ± 1.12 in Groups I, II and
III, respectively (Table 1). Though, this increment in
vitamin E levels was not found to be significant, which
may be due to the minor differences in age of different
groups. A ratio of < 0.6 mg in children under 12 years
and less than 0.8 mg total tocopherol per gram of
lipid in older children and adults, represents vitamin
E deficiency.1
conclusion
In conclusion serum vitamin E levels in healthy Indian
children is 2.82 ± 1.11µ and there is no sex predilection.
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Repair Aortic Coarctation Early and Follow for Life: 60-year Study
Babies born with a narrowing of the aorta should be followed for cardiac issues throughout their lives, say the
authors of a six-decade review of cases at the Mayo Clinic in Rochester, Minnesota. (Source: Medscape)

Presence of Eczema may Affect Infant Food Allergies

Infants with atopic dermatitis (AD), also known as atopic eczema, may be more likely than infants without AD
to be sensitized to commonly allergenic foods, according to an article published online July 18 in the Journal of
Investigative Dermatology. (Source: Medscape)

Less Sleep, More Behavioral Problems in Kids

Children who have relatively short nighttime sleep duration are at high risk for several externalizing behavioral
problems. A cohort study of almost 9000 preschool-aged children showed that those who averaged fewer than 9
hours of sleep per night were significantly more likely to show impulsivity, anger, and overactivity and to have
tantrums than their peers who averaged more nightly sleep. The children with less sleep were also 80% more
likely to show aggression. (Source: Medscape)

Finland Bucks the Trend: Type 1 Diabetes in Kids Flattens

An analysis of data from the Finnish National Institute for Health and Welfare on type 1 diabetes diagnosed in
children aged 0 to 14 years during 2006–2011 is published July 23 in a research letter in JAMA shows that the
incidence of type 1 diabetes appears to be leveling off in the country. Finland has the highest incidence of T1D in
the world, and its T1D registry is one of the longest-running. (Source: Medpage Today)

278 Indian Journal of Clinical Practice, Vol. 24, No. 3, August 2013