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PubMed1999

Do cry features reflect pain intensity in preterm neonates? A preliminary study.

The purpose of this study was to investigate if cries from preterm neonates would reflect changes in pain intensity following interventions. The cries from 25 preterm neonates from an original sample of 122 were audiorecorded while the infant was undergoing heelstick during a randomized crossover design testing the efficacy of: pacifier with sucrose or water, or prone position as compared to standard care. Both pacifier conditions reduced procedural pain according to a validated composite pain measure (the Premature Infant Pain Profile). There were proportionately fewer cries in the two pacifier groups compared to the prone positioning and standard care groups, and cry duration was positively correlated with PIPP scores. However, neither cry duration nor fundamental frequency reflected group differences. Further research is needed to determine if cry is a sensitive and valid indicator of pain in preterm infants.

Blood Specimen Collection↗
PubMed1994

Behavioral and physiologic effects of nonnutritive sucking during gavage feeding in preterm infants.

Behavioral and physiologic responsivity to nasogastric gavage feeding was assessed in 36 preterm infants on 2 consecutive d. On one of these days, a pacifier was provided during and after the gavage segment of the standardized protocol. The protocol was divided into segments that included baseline, preparatory handling, pregavage, gavage, and postgavage periods. Patterns of cardiac (heart period and vagal tone), oxygen saturation, behavioral state, and defensive behavioral responses to gavage were quantified. These stable preterm infants responded to handling and gavage feeding with reduction in heart period, vagal tone, and oxygen saturation. These responses were not altered by provision of a pacifier, although there was a tendency for fewer episodes of bradycardia and oxygen desaturation. Conversely, behavioral state was affected significantly by nonnutritive sucking: when provided with a pacifier, infants exhibited less behavioral distress, spent less time in fussy and active awake states during and after feeding, and returned to a sleep state significantly faster. There is converging evidence to suggest that nonnutritive sucking lessens behavioral distress to iatrogenic stressors but does not alter physiologic responsiveness.

Enteral Nutrition↗
PubMed2001

Pain management for neonatal circumcision.

Circumcision is the most common surgical procedure performed in the neonatal period in North America. If untreated, the pain of circumcision causes both short and long term changes in infant behaviours. The most widely studied pharmacological intervention for pain management during circumcision is dorsal penile nerve block (DPNB) by injected lidocaine (lignocaine). Randomised controlled trials have demonstrated its efficacy; infants premedicated with lidocaine have significantly smaller changes in physiological and pain-related behaviours compared with infants who are not given analgesics. A meta-analysis of injection-related adverse effects (bruising/haematoma) yielded a risk of 6.7% (95% confidence interval, 0.5 to 12.9%). Systemic toxicity from injected local anaesthesia has not been reported. Less effective modalities include topical anaesthesia with lidocaine-prilocaine cream [Eutectic Mixture of Local Anaesthetics (EMLA)], lidocaine cream and oral administration of sucrose. The good tolerability of lidocaine-prilocaine cream has been demonstrated by a lack of clinically significant methaemoglobinaemia when used appropriately. Nonpharmacological interventions (pacifier, specially designed restraint chair) reduce distress during the procedure, and paracetamol (acetaminophen) may provide postoperative analgesia. No single agent has been demonstrated to ameliorate pain for all infants undergoing circumcision. A multimodal approach of pharmacotherapy is currently recommended. Studies evaluating the efficacy of combined analgesia have demonstrated significant benefits for combinations of 2 or more forms of treatment (such as DPNB and sucrose-dipped pacifier) compared with single interventions. The instrument used to perform the circumcision is also important. The Mogen clamp has been shown to be associated with a shorter procedure time and less pain compared with the Gomco clamp. If circumcision is to be performed on infants, it is, therefore, recommended that combined analgesia and the Mogen clamp technique are used, and nonpharmacological stress reducing interventions such as pacifiers and comfortable restraining chairs should also be employed.

Acetaminophen↗
PubMed1997

Risk factors for colonization of salivary lactobacilli and Candida in children.

We analyzed the occurrence of salivary lactobacilli and Candida in a sample of 166 children aged 1-4 years (mean, 2.5 years) in relation to possible risk factors for colonization of the microbes. The risk factors examined were sucking habits, feeding habits, symptoms of respiratory infections, and antibiotic therapy at the time of sampling. Lactobacilli occurred in 18% of the children's saliva, and Candida in 24%. In the logistic modeling the variables most strongly associated with the occurrence of lactobacilli were pacifier-sucking (relative risk (RR), 2.9; 95% confidence interval (CI), 1.1-7.0; P = 0.01) and antibiotic therapy (RR, 4.6; CI, 1.2-16.9; P = 0.01). The association between positive Candida test and use of a pacifier was also significant (RR, 4.8; CI, 2.1-10.7; P = 0.0001). The results of the study suggest that the use of a pacifier increases the occurrence of both salivary lactobacilli and Candida. It could therefore be a factor influencing caries susceptibility and activity in children.

Anti-Bacterial Agents↗
PubMed2003

A pilot study of milk odor effect on nonnutritive sucking by premature newborns.

OBJECTIVE: To study the effect of milk odor on nonnutritive sucking by premature newborns. DESIGN: Blinded, crossover study of the effects of milk vs sham odor on nonnutritive sucking. SETTING: Urban neonatal intensive care unit. PATIENTS: Twenty-nine premature newborns with gestational age of 29 to 36 weeks. INTERVENTION: Fourteen subjects were tested with fortified breast milk odor (group 1) and 15 were tested with formula odor (group 2). For the test observation, milk odor was directed to the nose (orthonasal exposure) using a specially modified pacifier. For the control observation, water was used as a sham odor. Observations were made concurrently with tube feeding of the newborn with either fortified breast milk (group 1) or formula (group 2). MAIN OUTCOME MEASURES: Total number of sucks and sucking bursts, measured from a digital record of pressure changes within the pacifier. RESULTS: Nutrient odor increased suck bursts in group 1 subjects, with borderline statistical significance (46.6 bursts/10 min with odor [95% confidence interval (CI), 39-54] vs 35.4 bursts/10 min without odor [95% CI, 28-43]). Unexpectedly, when test and control observations were combined, subjects in group 1 showed an overall increase in number of sucks (260.4 [95% CI, 206-315]) and suck bursts (41.0 [95% CI, 36-46]) compared with group 2 subjects (144.8 [95% CI, 87-203] vs 27.4 [95% CI, 21-34]). CONCLUSIONS: Nutrient odor exposure via pacifier may stimulate nonnutritive sucking during gavage feeding of premature newborns. Further studies on the effects of nutrient odor on nonnutritive sucking by premature newborns must take into account the effects of nutrients given via gavage.

Apgar Score↗
PubMed2006

[Nipple confusion and breastfeeding: a literature review].

Among the ten steps to successful breastfeeding advocated by the WHO and UNICEF, steps six and nine clearly state that formula supplementation and pacifier use, except when medically necessary, should be avoided. Early formula supplementation may not only interfere with the mother's lactation but also result in nipple confusion on the part of the baby. To avoid nipple confusion, the encouragement of cup feeding and the non-provision of pacifiers or bottles are required nursing practice in baby-friendly hospitals. However, the relationship between nipple confusion and the duration of breastfeeding has not been well examined. The purpose of this paper is to explore the relationships between three methods of feeding (i.e. pacifier, bottle feeding, and cup feeding), nipple confusion, and duration of breastfeeding. A hypothetical framework is proposed to explain these relationships on the basis of a review of the literature.

Bottle Feeding↗
PubMedDate not supplied

Pain reduction interventions during neonatal circumcision.

The purpose of this study was to determine the effect of some noninvasive pain reduction interventions on pain in 121 neonates undergoing unanesthetized circumcision. Subjects were randomly assigned to one of six groups: classical music, intrauterine sounds, pacifier, music and pacifier, intrauterine sounds and pacifier, or control (no nurses present and no pain reduction interventions used). Physiological variables that were monitored were heart rate, rhythm, dysrhythmias, blood pressure, transcutaneous oxygen (tcpO2), rate pressure product, and behavioral state, measured during 14 circumcision steps. Over the 14 steps, 42% of the heart rates, 78% of the systolic blood pressures (SBP), 30% of the diastolic blood pressures (DBP), and 81% of the tcpO2 pressures were abnormal. Few significant differences were found among any of the steps. SBP and DBP differed significantly between groups during two of the noninvasive steps; and tcpO2 differed significantly during six steps.

Blood Pressure↗
PubMed1991

Sucrose as an analgesic for newborn infants.

The effectiveness of sucrose as an analgesic agent for newborn infants was assessed during two standard painful hospital procedures: blood collection via heel lance and circumcision. Infants who drank 2 mL of a 12% sucrose solution prior to blood collection cried 50% less during the blood collection procedure than did control infants who had received 2 mL of sterile water. Crying of infants who ingested sucrose returned to baseline levels within 30 to 60 seconds after blood collection whereas control infants required 2.5 to 3.0 minutes to return to baseline. Like findings were obtained for infants who received sucrose on a pacifier prior to and during circumcision. Specifically, control infants who underwent a standard circumcision procedure without intervention cried 67% of the time. A water-moistened pacifier reduced crying to 49% (P less than .01). Crying was reduced further to 31% (P less than .05) by providing infants with a sucrose-flavored pacifier to suck. These findings, which parallel results obtained in studies of pain in infant rats, provide a potent yet simple, benign intervention to help alleviate stress and pain routinely experienced by human infants.

Administration, Oral↗
PubMed1982

Amount of sucking when a sucking object is readily available to human newborns.

In order to find out how much sucking human newborns evidence when a sucking object is readily available, pacifiers were given to 10 newborns in response to the spontaneous occurrence of empty sucking, rooting, and mouthing and were left in their mouths until the babies relinquished them. The spontaneous occurrence of these behaviors and of finger sucking was also observed in a control group of 10 babies. Both groups were observed continually during the 2 hours before a feeding and the first hour afterward, starting before the very first feeding and continuing at regular 24-hour intervals for 4 days. The amount of time spent sucking a pacifier or finger(s) was recorded for both groups. The results indicated that the newborns spent about half an hour per hour sucking a pacifier starting on the very first day of life, and that this did not vary with feeding experience. They also indicated that some newborns in the control group sucked their fingers, 1 for considerable periods of time. The results suggest that human newborns, like other newborn mammals, program considerable sucking time for themselves regardless of whether or not milk is forthcoming.

Fingersucking↗
PubMedDate not supplied

Comparison of analgesics in ameliorating the pain of circumcision.

OBJECTIVE: Our objective was to compare two methods of pain control during neonatal circumcision: a sucrose-dipped pacifier and an analgesic cream (EMLA). STUDY DESIGN: This study was conducted in our well-baby nursery where 80 male infants were placed into one of four groups: control (water-dipped pacifier only), sucrose alone, EMLA alone, or sucrose and EMLA. Heart rate, oxygen saturation, systolic and diastolic blood pressure, and crying time were measured as indicators of pain. The primary data analysis was a 2 x 2 factorial analysis of variance with repeated measures. RESULTS: Physiologic and behavioral parameters indicated significantly (p < 0.05) decreased pain response in all treatment groups compared with that in the control group. The combination of sucrose and EMLA was most effective in reducing pain responses; sucrose alone was significantly less effective. There were no side effects of treatment. CONCLUSION: Pain during neonatal circumcision can be optimally ameliorated by combined use of a sucrose-dipped pacifier and a local analgesic cream.

Analgesics↗
PubMed2005

Factors affecting exclusive breastfeeding in Poland: cross-sectional survey of population-based samples.

OBJECTIVE: To identify factors affecting exclusive breastfeeding in maternity hospital care and during the first six months after birth. METHODS: Two cross-sectional surveys form the basis of this study: the first, conducted in 1995 on maternity wards (n = 11,422 newborns) and the second, conducted in 1997 in primary care centers (n = 10,156 infants under six months). RESULTS: The most meaningful factors in hospital care were: cesarean section, breastfeeding initiation after 2 h, lack of skin to skin contact, use of pacifiers, separation longer than 1h/24 h and health problems of infants. After hospital discharge the most significant factors were: use of pacifiers, mothers reluctance to exclusive breastfeeding longer then four months, low level of mother and father education. CONCLUSIONS: Most of identified factors can be modified so our results can help to introduce more effective target intervention.

Adult↗
PubMed2006

Stop SIDS--sleeping solitary supine, sucking soother, stopping smoking substitutes.

UNLABELLED: The recognition of prone sleeping and maternal smoking as modifiable risk factors for sudden infant death syndrome (SIDS), has drastically decreased SIDS incidence. However, during the last years other factors have become necessary to consider to further reduce the risk of SIDS. Side sleeping implies a greater risk than supine sleeping but is still common. Bed sharing may increase the risk of SIDS, while use of a pacifier seems to be protective. Replacement of maternal smoking with nicotine substitutes is not harmless. CONCLUSION: To further reduce the risk of SIDS, exclusive supine sleeping should be encouraged and side sleeping discouraged. When the breast-feeding is established, a pacifier can very well be used at bedtime. Bed sharing can increase the risk of SIDS if the infant is below 2-3 months of age, especially if the mother is a smoker. Any nicotine use should be avoided during pregnancy and breast-feeding.

Humans↗
PubMed2007

Social and biological early life influences on the prevalence of open bite in Brazilian 6-year-olds.

OBJECTIVE: Little is known about the effects of social and biological risk factors for open bite on the primary dentition. The aim of this study was to assess the early-life risk factors affecting anterior open bite. METHODS: A cross-sectional study using a birth cohort was carried out in Pelotas, Brazil. A sample of 400, 6-year-old children was employed. The Foster and Hamilton criteria were used to classify open bite. Data concerning social conditions, and perinatal and childhood health and behaviour were obtained from birth to 12 months of age and during the fifth year of the children's lives. Unconditional bivariate and multiple logistic regression analysis were performed. RESULTS: The prevalence of anterior open bite was 46.3%. Risk factors included: a maternal age of between 30 and 39 years, as compared with children whose mothers were younger; breast-feeding for < 9 months; dental caries experience; pacifier sucking between 12 months and 5 years, as compared to no sucking or a shorter duration of sucking; and the presence of finger-sucking at 6 years of age. CONCLUSION: Open bite in the primary dentition was associated with older mothers, early weaning, dental caries occurrence, long-term use of a pacifier and finger-sucking at 6 years of age. These findings support the common risk approach for intervention to prevent open bite in the primary dentition.

Bottle Feeding↗
PubMed2006

[Factors associated with breastfeeding duration in three cities in the region of Alto Jequitinhonha, Minas Gerais, Brazil].

The objective of this study was to identify and analyze variables associated with shorter duration of breastfeeding in the Alto Jequitinhonha region, Minas Gerais, Brazil. This was a cross-sectional study, using retrospective data, in three cities of the region. All children up to 24 months of age were considered in the study, with a total sample of 450 children. Statistical analyses employed the Kaplan-Meier method and Cox regression model. Three variables were found to be associated with breastfeeding duration. Risk of premature interruption was 1.59 [1.08;2.36] times higher if the father had completed the second grade or greater in school, 1.52 [1.00;2.34] times higher if the father did not live with the child, and 3.07 [2.17;4.34] times higher if child had used a pacifier. Thus, greater education of fathers, use of pacifiers by children, and fathers not living with the children were factors associated with shorter duration of breastfeeding.

Adult↗
PubMed2006

Prevalence of exclusive breastfeeding and its determiners in the first 3 months of life in the South of Brazil.

OBJECTIVE: To determine the prevalence of exclusive breastfeeding during the first 3 months of life and its determinant factors in a city in the South region of Brazil. METHODS: Prospective study of a cohort of babies born between September 2002 and May 2003 in the city of Pelotas, RS. Data were obtained in interviews, at maternity units and during home visits, with mothers of babies aged between 1 and 3 months. Factors related to the cessation of breastfeeding were subjected to univariate, bivariate and multivariate analysis. RESULTS: Nine hundred and forty mothers of children aged 3 months or less were interviewed, 39% of whom were still exclusively breastfeeding and around 1/3 of whom no longer breastfed. Multivariate analysis by logistic regression demonstrated a significant association between interruption of exclusive breastfeeding before 3 months and maternal employment, use of a pacifier, low family income (between one and three times the minimum wage), and less than 5 years' paternal education. CONCLUSIONS: Exclusive breastfeeding throughout the first 3 months of life is an uncommon practice among the population of Pelotas, RS, in particular when the mother works away from home, the father has little education and the child is given a pacifier, which reinforces the need to continue stimulating exclusive breastfeeding during the first months of life.

Brazil↗
PubMedDate not supplied

The effects of infant feeding patterns on the occlusion of the primary dentition.

The purpose of this study was to investigate the effects of different methods of infant feeding on the development of the occlusion in the primary dentition. The study included 126 children. Parents completed questionnaires regarding feeding and health history, and the primary dental occlusion was recorded for each child. The authors found that: (1) predominant bottle-feeding between 0 and 6 months of age was associated with the development of a pacifier habit; (2) children who used a pacifier were more likely to develop a nonmesial step occlusion, an overjet >3 mm, and an open bite; (3) children who sucked their thumb were more likely to develop an overjet >3 mm; and (4) in the absence ofnonnutritive oral habits, children who were predominantly bottle-fed between 0 and 6 months of age were more likely to develop an overbite >75%, although just shy of nominal statistical significance.

Age Factors↗
PubMedDate not supplied

Feeding, artificial sucking habits, and malocclusions in 3-year-old girls in different regions of the world.

PURPOSE: The way babies and young children are reared is important to their health and development. Extensive breast-feeding has also been shown to reduce the development of artificial sucking habits like digit or pacifier-sucking. The aim of this study was to determine feeding methods, artificial sucking habits, and the presence of malocclusions in 3-year-old girls living in different regions of the world. METHODS: Children from the following countries were involved in the present study: (1) Brazil (Porto Alegre); (2) Japan (Niigata); (3) Mexico (Mexico City); (4) Norway (Oslo); (5) Sweden (Falköping); (6) Turkey (Istanbul); (7) and the United States (Iowa City, Iowa). During the interview and examination, the following variables were evaluated and registered: (1) breastfeeding and bottle-feeding; (2) duration and frequency; (3) sucking habits; (4) posterior and anterior crossbites; and (5) other malocclusions/normal occlusion. RESULTS: The prevalence of breast-feeding was very high in all groups, ranging between 78% and 98%. The prevalence of bottle-feeding in the different areas was also high. Except for Iowa City, the prevalence of digit-sucking was relatively low. Pacifier-sucking is fairly popular in most areas, with the exception of Niigata. The prevalence of normal occlusion in different cities ranged from 38% to 98%. CONCLUSIONS: There are considerable differences in feeding, as well as artificial sucking habits, in different areas of the world and at different periods.

Bottle Feeding↗
PubMed2002

A systematic review of nonpharmacological and nonsurgical therapies for gastroesophageal reflux in infants.

BACKGROUND: Nonpharmacological and nonsurgical measures are often recommended for gastroesophageal reflux disease (GERD) in infants, despite ambiguous supporting evidence. OBJECTIVE: To conduct a systematic review of rigorously evaluated nonpharmacological and nonsurgical therapies for GERD in infants. DESIGN/METHODS: We searched online bibliographic databases, including MEDLINE, EMBASE, the Cochrane Collaboration and Clinical Trials Database, and alternative medicine databases for the terms gastroesophageal reflux and infants. We selected randomized controlled trials of nonpharmacological and nonsurgical GERD therapies in otherwise healthy infants. Data were extracted from the selected articles regarding reflux, emetic episodes and intraesophageal pH. RESULTS: We identified 43 relevant studies, of which 10 met the selection criteria. These studies examined positioning, pacifier use, and feeding changes. Positioning at a 60 degree elevation in an infant seat was found to increase reflux compared with the prone position. No significant difference was shown between the flat and head-elevated prone positions. The impact of pacifier use on reflux frequency was equivocal and dependent on infant position. The protein content of formula was not found to affect reflux. Although no study demonstrated a significant reflux-reducing benefit of thickened infant foods compared with placebo, 1 study detected a significant benefit of formula thickened with carob bean gum compared with rice flour (pH<4 for 5% vs 8% of time). Another study showed that if supplementing with dextrose 5% water or dextrose 10% water, the lower-osmolality fluid was associated with less reflux. CONCLUSIONS: Many conservative measures commonly used to treat GERD in infants have no proven efficacy. Although thickened formulas do not appear to reduce measurable reflux, they may reduce vomiting. Further studies with clinical outcomes are needed to answer questions about efficacy definitively.

Gastroesophageal Reflux↗