Purpose
The National Immunization Survey-Child (NIS-Child) questionnaire was modified in 2004 and in 2006 to obtain more accurate and useful information about breastfeeding. This page describes these changes.
Wording of the breastfeeding questions
The breastfeeding questions used in the NIS-Child survey were modified in 2004 and 2006 (Table A1). The history of how and why the questions were changed makes clear why trends of exclusive breastfeeding and supplementing breast milk with formula for children whose caregivers were interviewed before December 31, 2005, are not provided.
In January 2004, the third breastfeeding question was modified slightly to remove "or water" from the first part of the question. Water was added to the list of items other than breast milk. Additionally, interviewers were instructed to always read the clarification of foods and liquids to consider. Changing the question had a minimal effect on answers to the question about the rate of exclusive breastfeeding at 3 and 6 months.
Additional changes were made in 2006 to two NIS-Child survey breastfeeding questions (Table A1). These changes were made based on cognitive testing results for questions used before 2006.
Question 2 was revised to read "How old was [child's name] when [child's name] completely stopped breastfeeding or being fed breast milk?" The wording change on question 2 resulted in a minimal effect on the reported duration of breastfeeding.
Question 3, which read "How old was [child] when s/he was first fed something other than breast milk?", was asked as two separate questions (Question 3 and Question 4) in 2006. This change led to significantly lower estimates of exclusive breastfeeding. Because of this large effect, CDC only shows trends of exclusive breastfeeding and supplementing breast milk with formula for children whose caregivers were interviewed after December 31, 2005.
The 2006 breastfeeding questions continue to be used in the NIS-Child survey.
Table A1
Changes in breastfeeding questions, National Immunization Survey-Child 2001-Present
Questions 2001–2003
Questions 2004–2005
Questions 2006–present
1. Was [child] ever breastfed or fed breast milk?
1. Was [child] ever breastfed or fed breast milk?
1. Was [child] ever breastfed or fed breast milk?
2. How long was [child] breastfed or fed breast milk?
2. How long was [child] breastfed or fed breast milk?
2. How old was [child’s name] when [child’s name] completely stopped breastfeeding or being fed breast milk?
3. How old was [child] when s/he was first fed something other than breast milk or water? [If respondent hesitates, add: This includes formula, juice, cow’s milk, sugar water, solid foods, or anything else.]
3. How old was [child] when s/he was first fed something other than breast milk? This includes formula, juice, cow’s milk, water, sugar water, solid foods, or anything else.
3. How old was [child’s name] when (he/she) was first fed formula?
4. This next question is about the first thing that [child] was given other than breast milk or formula. Please include juice, cow’s milk, sugar water, baby food, or anything else that [child] may have been given, even water. How old was [child’s name] when (he/she) was first fed anything other than breast milk or formula?