title: Maternal reported indicators and causes of insufficient milk supply.
abstract: BACKGROUND
  Although the breastfeeding initiation rate is high in China, exclusivity is low. Not having enough breast milk has been frequently reported as a reason for supplementing and weaning.
  
  
  OBJECTIVE
  The objective was to explore maternal perception of indicators and causes of self-reported insufficient milk supply (IMS) among a sample of southwestern Chinese mothers.
  
  
  METHODS
  This was a cross-sectional study, conducted in a hospital in Chengdu, China.
  
  
  RESULTS
  The majority of mothers were of Han ethnicity and primiparous. Most initiated breastfeeding (n = 325, 95.3%). Among mothers who had weaned by the time of questionnaire completion, more than half (n = 52) reported IMS as a reason, and 53.8% of these mothers reported this occurring during the first 2 days postpartum. Mothers often identified IMS by using less sensitive indicators of adequate intake such as receiving a hungry look from the infant after nursing (34.6%) and not feeling the presence of milk (28.8%). More sensitive indicators of adequate intake, such as the number of wet/soiled diapers, were not reported. More than a third of mothers (39.2%) could not express a reason for the occurrence of IMS. Among those who identified reasons, nearly one-fourth of mothers attributed IMS, at least partially, to dietary factors such as poor appetite (23.5%).
  
  
  CONCLUSIONS
  Self-reported IMS appears to be a common barrier to breastfeeding continuation among this sample of Chinese mothers. Culturally appropriate intervention, designed to inform mothers how to correctly identify and address IMS, might be an effective strategy to support optimal infant-feeding behaviors in China.
authors.affiliation: Department of Nutrition, The University of Tennessee, Knoxville, TN, USA.
authors.forename: Zixin
authors.initials: Z
authors.lastname: Lou
authors.affiliation: West China School of Public Health, Sichuan University, Chengdu, China zgmu2003@126.com.
authors.forename: Guo
authors.initials: G
authors.lastname: Zeng
authors.affiliation: West China School of Public Health, Sichuan University, Chengdu, China.
authors.forename: Lujiao
authors.initials: L
authors.lastname: Huang
authors.affiliation: West China School of Public Health, Sichuan University, Chengdu, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.affiliation: West China School of Public Health, Sichuan University, Chengdu, China.
authors.forename: Lan
authors.initials: L
authors.lastname: Zhou
authors.affiliation: Department of Nutrition, The University of Tennessee, Knoxville, TN, USA.
authors.forename: Katherine F
authors.initials: KF
authors.lastname: Kavanagh
mesh_terms: D000328:Adult; D001942:Breast Feeding; D002681:China; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007774:Lactation; D008297:Male; D008425:Maternal Behavior / Q000523:psychology; D009035:Mothers / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: China; breastfeeding; insufficient milk supply; weaning