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PubMed1988

The effect of nonnutritive sucking on heart rate in preterm infants.

A laboratory and a field experiment used within-subject designs to test the hypothesis that nonnutritive sucking (NNS) reduces heart rate (HR) in preterm infants. Infants in Experiment A were provided a standard pacifier nipple for 30 min under strictly controlled conditions. In the field Experiment B, nursing staff provided infants with a standard pacifier during alternate intervals in a sequence of four interfeed intervals spanning 12 hr. NNS significantly reduced average HR in each experiment. Given the strongly positive relationship between HR and energy expenditure, these results suggest that NNS reduces energy expenditure in preterm infants. Such an effect, in turn, could help to explain how the opportunity to engage in NNS enhances growth in preterms.

Arousal↗
PubMed2000

Provision of supplementary fluids to breast fed infants and later breast feeding success.

It has been shown that altering hospital policies in a way to avoid interference of routine prescriptions with initiation of breast feeding and to provide active encouragement to mothers and personnel can result in significant benefit for later breast feeding success. It is less clear, however, which of the elements of a promotional programme such as UNICEF/WHO's "ten steps to successful breast feeding" are absolutely essential and which can be adapted to local cultural habits. We performed an open randomized multicenter study in Switzerland to evaluate, whether restriction of supplementary fluids for breast fed infants in the first week of life and strict avoidance of artificial teats and pacifiers affects later breast feeding success. Follow up to 6 months was ensured by mailed questionnaires. 602 mother infant pairs were enrolled. Of 294 infants in the intervention group 39% were excluded from the final analysis because of protocol violations, mainly maternal request for the use of pacifiers or bottles. Though the number of dextrin maltose supplements during the first two days (1.7 vs. 2.2 on day 1, 2.2 vs. 2.6 on day 2) and the percentage of infants receiving any supplement (85% vs. 96.6%) was significantly smaller in the intervention group, the difference was disappointingly small. The prevalence of breast feeding was 100% vs. 99% at day 5, 88% vs. 88% at 2 months, 75% vs. 71% at 4 months and 57% vs. 55% at 6 months, none of the differences being significant. We conclude that rigorous adherence to all of the ten steps may encounter obstinate resistance from cultural habits even in a population highly favourable to breast feeding. An improvement in adherence does not necessarily lead to better breast feeding success. The results of the few comparable studies in the literature show also that cultural practices during the first months of life may influence profoundly the long term effects of interventions during the first days of life.

Breast Feeding↗
PubMedDate not supplied

Sudden infant death syndrome--are parents getting the message?

BACKGROUND: Factors that place an infant at increased risk of sudden infant death include the prone sleep position, overheating and parental smoking, while practices such as bottle-feeding, co-sleeping and the use of pacifiers remain controversial. Major publicity campaigns have been undertaken, which have included the distribution of printed material and extensive media coverage. AIMS: To examine if Irish parents follow the currently recommended childcare guidelines to reduce the risk of sudden infant death and to examine factors that may have impact on their acceptance. METHODS: A random selection of 197 infants from the Birth Register of the Eastern Health Board. Parents were interviewed and a semi-structured survey questionnaire was completed. RESULTS: Forty one per cent of infants are still placed on their side to sleep, an inherently unstable position. First time parents are more likely to place their infants on their backs. Over 60% of infants are exposed to one or more adults smoking in the home despite parental knowledge of its association with sudden infant death syndrome (SIDS). Sixty eight per cent of infants are overwrapped at night and parental understanding of what constitutes overwrapping is poor. Thirteen per cent of infants regularly co-sleep with their parents and 20% of these parents smoke. Pacifier use is common. CONCLUSION: Future programmes should target first time parents, should provide clear information regarding appropriate infant thermal environment, and should ensure regular updating of medical personnel so that they can instruct families on best current practice. Smoking remains a significant health issue with an impact on sudden infant death.

Adult↗
PubMedDate not supplied

Epidemiology of intrathoracic petechial hemorrhages in sudden infant death syndrome.

The possible effects of a wide range of sociodemographic and environmental factors on the incidence and distribution of petechiae were investigated in 485 sudden infant death syndrome (SIDS) cases from the New Zealand Cot Death Study. The number (nil, few, many) of macroscopic petechial hemorrhages in the visceral pleura, capsule of thymus, and epicardium was recorded in 458 of 474 autopsied SIDS cases. Other information was obtained from parental interview and obstetric records. Univariate analysis showed highly significant relationships (P < or = 0.005) between the frequency of petechiae at one or more sites and socioeconomic status, parity, breast feeding, age at death, time of death, sleep position, and head covering at death and lesser but significant relationships (P < or = 0.05) with Maori ethnicity, birth weight, gestation, pacifier use, and bed sharing. After multivariate analysis, significant associations remained between increased frequencies of thymic petechiae and parity (P = 0.0001), age at death (P = 0.0003), Maori ethnicity (P = 0.0019), pacifier use (P = 0.0001), and head covering at death (P = 0.0032); between increased frequencies of epicardial petechiae and head covering at death (P = 0.008) and an estimated time of death between 00:00 and 05:59 h (P = 0.056); and between increased frequencies of pleural petechiae and maternal smoking (P = 0.058) and parity (P = 0.022). There was a decreased frequency of pleural petechiae in infants placed prone for their final sleep (P = 0.058). The distribution and frequency of petechiae are affected by environmental factors, including known risk factors for SIDS, but these factors occur inconsistently across the three sites. The findings imply differences in the pathogenesis at each site but do not provide consistent support for previous theories of causation of petechiae.

Analysis of Variance↗
PubMed2005

[Nonpharmacologic management of pain in neonates].

It has taken a staggering amount of time for the medical community to realize that new-borns are able to feel pain. The treatment of neonatal pain during procedures has become mandatory, not only for humanitarian reasons which could alone justify the soothing of pain in these infants but also because repeated and prolonged pain may have long-term consequences in neonates. Nonpharmacological interventions which comprise environmental and behavioral interventions have a wide applicability for neonatal pain management alone or in combination with pharmacological treatments. These interventions are not necessarily substitutes or alternatives for pharmacological interventions but are complimentary. Nonpharmacological interventions can reduce neonatal pain indirectly by reducing the total amount of noxious stimuli to which infants are exposed and directly, by blocking nociceptive transduction or transmission or activation of descending inhibitory pathways or by activating attention and arousal systems that modulate pain. This article describes prevention, environmental interventions, and behavioral strategies. Within the behavioral strategies, sweet solutions, especially sucrose and glucose, with or without non-nutritive sucking, skin to skin contact, and breastfeeding during procedures have been studied and their analgesic efficacy has been shown. A practical approach is described hereafter. Give 1-2 ml of oral sucrose or glucose 30% at 2 min before a minor painful procedures in term neonates or neonates weighing more than 2500 g. The analgesic efficacy of sucrose and glucose seems similar. For preterm neonates weighing less than 2500 g, give 0.5 ml of oral sucrose or glucose 30%, and for those weighing less than 1500 g, 0.3 ml of oral sucrose or glucose 30%. Since a synergistic effect has been shown for the association of sweet solutions and pacifiers, give a pacifier together with sweet solutions. For term neonates that are breastfed, consider breastfeeding during procedures. These nonpharmacological interventions are suitable for minor procedures. They should not constitute the sole analgesic when performing more invasive procedures.

Humans↗
PubMed2003

Effects of chewing gum on responses to routine painful procedures in children.

In infants, sweet taste and sucking on a pacifier both have analgesic effects. Animal studies suggest that sweet taste may involve opioids, while rhythmic oral movements, as with a pacifier, increase the release of serotonin, which is involved in the gating of nociceptive afferents. The present study was designed to see if these effects produce an analgesic effect in children. Two studies were performed, during blood draws in a pediatric test center in 7- to 12-year-old children, and during vaccination at school in 9- to 11-year-old children. Using unsweetened or sweetened chewing gum, there were four groups: control, sweet, chew, and sweet plus chew. Overall, there was no effect of either sweet taste or chewing on pain responses. However, in boys sweet taste tended to increase pain ratings, but only in conjunction with chewing, while in girls sweet taste tended to decrease pain ratings in conjunction with chewing and increased them in the absence of chewing. Ratings of pain intensity and affective state were correlated. Affective state before the painful stimulus was related to pain response in the girls and in the boys in the test center, but not in the schools. In the schools, the presence of peers may have influenced the ratings.

Blood Specimen Collection↗
PubMed2002

Microbiologic findings and risk factors for antimicrobial resistance at myringotomy for tympanostomy tube placement--a prospective study of 601 children in Toronto.

CONTEXT: There is limited information on the identity and antibiotic susceptibility of bacterial pathogens in children with chronic otitis media whose repeated antibiotic use may place them at increased risk of antibiotic-resistant bacteria. OBJECTIVE: To determine, at myringotomy for tympanostomy tube placement, (1) the prevalence of bacteria, (2) the extent and patterns of antibiotic resistance, and (3) the risk factors associated with the presence and resistant status of pathogens. DESIGN: Prospective, multi-site, cohort study. SETTING AND PATIENTS: Children undergoing myringotomy for tympanostomy tube placement between November 1, 1999 and March 31, 2000 in seven hospitals in Toronto, Ontario, were identified. If fluid was present, aspirates were submitted for bacteriologic testing. A follow-up telephone questionnaire was administered to patient caregivers in order to identify risk factors for the presence of (1) culturable pathogens and (2) resistant pathogens. MAIN OUTCOME MEASURES: The identification and prevalence of bacteria cultured from the middle ears of subjects, and the degree of nonsusceptibility to commonly prescribed antibiotics. RESULTS: Among 601 patients (mean age 3.9 years, 60.7% male), both a telephone interview (n=544) and an ear specimen (n=527) were obtained for 478. Pathogens were found in middle ear effusions of 37% of the children in the study; including at least one 'definite' pathogen in 189 children (31.4%), and a further 32 children (5.3%) with at least one 'possible' pathogen. Definite pathogens included Haemophilus influenzae in 17% of the children, followed by Moraxella catarrhalis (9%) and Streptococcus pneumoniae (6%); ampicillin nonsusceptibility was found in 40, 100 and 24%, respectively. Overall, 123 children (20.5%) were found to have definite pathogens with resistance to ampicillin/penicillin, trimethoprim-sulfamethoxazole, or clarithromycin/erythromycin. Patient characteristics included premature birth and/or long length of stay in the nursery (23%), first infection before the age of 6 months (26%), put to bed with a bottle (28%), household smoker (34%), in out-of-home child care (38%), history of eczema, bronchiolitis and/or asthma (39%), and use of pacifiers (40%). Household characteristics were smoking (34%), married/common law parents (85%), and 60% had completed college or university; in 26% both parents were born outside of Canada; 73% of children were Caucasian. Of the 75% who responded to the question regarding income, 42% had household income over $60,000 (CAN). Risk factors for the presence of a pathogen and for a resistant pathogen in multivariate analysis included younger age, lower maternal education, day care centre attendance, no previous adenoidectomy and bilateral, primarily winter infections as well as amoxicillin use in the previous 6 months. CONCLUSION: Modifiable risk factors for otitis media including household smoking and pacifier use are present in many children undergoing tympanostomy tube placement; child care centre attendees are over-represented. Multiple antibiotic courses were commonly prescribed prior to surgery. H. influenzae and M. catarrhalis are important pathogens and therapy in clinical failures should be directed against them. The 7-valent protein conjugate polysaccharide vaccine (Prevnar) would have covered 73% of the serotypes of S. pneumoniae isolated in this study.

Adolescent↗
PubMed1999

Age-related acquisition of oral and nasopharyngeal yeast species and stability of colonization in young children.

The occurrence and stability of colonization of oral yeast species and strains was determined from 40 healthy children during a 22-month follow-up at the ages 2, 6, 12, 18 and 24 months. In addition, salivary samples were obtained from the mothers at baseline (2 months) to study the role of the mother as the source of yeasts for the child. Yeasts were recovered at least once from 17/40 (43%) children by the age of 2 years. Of the 40 children, 11 (28%) were yeast-positive at multiple sampling occasions. No significant differences were found in recovery frequency of yeasts at different ages. Candida parapsilosis was isolated in 18/33 (55%) yeast-positive samples, and it predominated (share of positive findings 76%) at ages 12 to 24 months. The same yeast species was rarely detected in successive follow-up samples and thus on species level yeasts were transient colonizers in the developing oral flora of the children. Of the mothers 20/40 (50%) harbored yeasts. Candida albicans was recovered from 19/20 (95%) of the yeast-positive mothers and C. parapsilosis from none. Only 7/20 (35%) of the mothers with a yeast-positive finding had a yeast-positive child. In 5/7 (71%) of these mother-child pairs, both harbored the same yeast species (C. albicans) and in 3/5 (60%) of the pairs the AP-PCR profiles of the yeast isolates were identical suggesting possible transmission. In children, significant relationships (Fisher's exact-test, P < 0.05) were found between recovery of yeasts and use of pacifier at age over 12 months, eruption of first teeth at age over 6 months, mother cooling the child's food by blowing and mother cleaning the child's pacifier in her own mouth. In mothers, a significant relationship existed between recovery of yeasts and use of antibiotics.

Adult↗
PubMed2004

The behavior and routes of lead exposure in pregrasping infants.

Understanding the routes of lead exposure in a very young infant is an essential precursor to identifying effective strategies for minimizing blood-lead (PbB) levels throughout infancy. The present study integrated observational data, lead-loading data, and household airborne particulate levels <10 microm (PM(10)) to understand the broad patterns of lead exposure in infants from Port Pirie, South Australia. Seven, 2-19-week-old infants were observed between three and six times, for 3-9 h per visit, at intervals of 1-9 weeks. Household lead-loading and PM(10) data were collected for five of the families. Eight objects were observed in an infant's mouth, but only the infant's fingers, pacifier, and nipple of the mother's breast or teat of a bottle were observed in an infant's mouth for an average of more than 1% of an observation day. The objects most frequently put in an infant's mouth were their own fingers or their pacifier. Synthesizing our data on behavioral frequency, lead loading, and the surface area of contact, and using estimates of dose response, and sampling, transfer, and absorption efficiencies, the results suggest that a 4-month-old infant could absorb up to 4 microg of lead a day (equivalent to a PbB level of up to about 2.4 microg/dl) by mouthing their fingers, about two-thirds of all exposure routes identified in this study. Estimates also suggest that lead uptake via inhalation accounts for about 0.5-3% of an infant's PbB at 5 microg/dl. If our estimates reflect real routes and values, the majority of the average PbB level of 6-month-old infants in Port Pirie during 2002 could potentially be accounted for by the normal infant and family behaviors observed in this study. While the current level of concern is 10 microg/dl, recent studies indicate no safe threshold for Pb exposure, and so interventions for reducing chronic low-level exposure are useful. We suggest that home-based interventions for reducing Pb exposure should focus on maintaining low Pb loadings on objects that are directly associated with an infant, and outside objects that have few transfer steps to the infant.

Cohort Studies↗
PubMedDate not supplied

Ingestion of carcinogenic N-nitrosamines by infants and children.

Volatile N-nitrosamines are very potent carcinogens. They can be approximately 5 million times more powerful than saccharin. One of two principal methods is generally used when assaying rubber products for nitrosamine content: (1) the German method (aqueous extraction) or (2) the U.S. method (dichloromethane extraction). When 16 types of baby-bottle nipples and children's pacifiers were tested recently, relatively high levels of nitramines, nitrosamines, and nitrosatable precursors were found. Eighty-one percent failed to meet the strict Dutch standards (based on the German method), but only 37.5% would have been banned according to U.S. regulations, which ignore nitrosatable-precursor content. Up to one-third of the nitrosamines present in a rubber nipple may migrate into the milk in the bottle within a few hours. Transfer into infant formula may exceed 40%, and transfer into saliva may be even higher. Thus, a highly contaminated nipple may cause a 5-kg infant who drinks 1 l/d to ingest approximately 2 micrograms/kg body weight.d of nitrosamines. To this, add any exposure resulting from pacifier use or from in vivo nitrosation of precursors. Therefore, daily exposure of infants may, in the worst case, conceivably reach 4-5 micrograms/kg body weight.d. Entire average daily exposure of an American adult to volatile nitrosamines from major sources is estimated to be less than 0.05 micrograms/kg body weight.d. Infants who use products like those tested may, therefore, be exposed daily to less than or equal to 100 times more of these carcinogens than are adults.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1999

Factors associated with initiation and duration of breastfeeding in Italy.

To evaluate factors associated with initiation and duration of breastfeeding in Italy, 1601 (73%) respondents among 2192 randomly selected mothers were interviewed within 1 mo of delivery. Mothers who started breastfeeding (85%) were followed-up for 12 mo. A compliance rate of 100% was obtained. At multiple logistic regression analysis, mother having been breastfed herself (p < 0.01), nursing guidance in the maternity ward (p = 0.01) and higher social class (p = 0.03) were positively associated with initiation of breastfeeding. We found that 42%, 19%, 10% and 4% mothers were still breastfeeding at 3, 6, 9 and 12 mo after delivery, respectively. Cox multiple regression analysis showed a negative association between duration of breastfeeding and pacifier use (p < 0.01), and a positive association with a higher level of maternal education (p = 0.04). Formula supplementation in the maternity ward (given to 30% of infants) was associated with a shorter duration of exclusive breastfeeding (p = 0.03). Mothers need support with breastfeeding, particularly those from lower social backgrounds and with lower levels of education. Early use of the pacifier should be discouraged.

Adult↗
PubMed2005

Women's experiences of bulimia nervosa.

AIM: This paper reports a study to interpret and understand bulimia nervosa as women experience it. BACKGROUND: Research into bulimia nervosa has focused on prevalence rates, health complications, comorbidity, neurochemical dysregulation, and cultural influences. Despite a multitude of investigations, little published research appraised bulimic women's personal experiences and understanding of this disorder. Such an understanding would assist health care professionals in providing sensitive, empathetic care. METHOD: The principles of Heideggerian phenomenology guided the study. Participants were 13 actively bulimic women, aged 18-36 years, with lengths of illness from 1 to 23 years. Data were obtained through interviews, personal diaries, and demographic questionnaires. FINDINGS: Participants' narratives revealed four themes that characterized the experience of living with bulimia: isolating self, living in fear, being at war with the mind, and pacifying the brain. The practices bulimic women engage in are carried out in secret, and hence participants experienced isolation. Binge eating and self-induced vomiting are considered abnormal behaviours; therefore, participants believed that they were subjected to negative public perceptions, which led to the experience of living in fear. The women feared being judged if others knew about the disorder. Several feared living without bulimia because it had become a significant part of their identity. In addition, these women were terrified of gaining weight or becoming fat. They experienced an internal struggle with the mind. In order to pacify the inner voice, many fed the compulsion to eat, and this resulted in guilt. The women subsequently balanced the experience by getting rid of fullness and erasing guilt, which was primarily achieved through self-induced vomiting. CONCLUSIONS: Understanding the experience of bulimia for women who suffer from this disorder is important. Bulimia often presents as a chronic and potentially lifelong health issue. Awareness of bulimic women's perspectives could promote a comprehensive appreciation of bulimia, its aetiology, and directions for treatment alternatives.

Adolescent↗
PubMed1995

Oral candidal flora in healthy infants.

Asymptomatic oral candidal carriage has been extensively studied in adults, but only rarely in infants. The present investigation aimed to determine the asymptomatic oral carriage of candidal species in healthy infants and its relationship to age, sex, feeding pattern and use of a pacifier. The swab technique was used for oral candidal isolation. Candidal species were isolated from 48% of the infants without a significant relationship to age, gender or between breast-fed or bottle-fed infants. Similarly, a history of maternal vaginal candidosis, or presence of nappy rash, had no significant relationship to oral candidal carriage. Infants who routinely sucked a pacifier had a significantly higher rate of oral candidal carriage, suggesting a reservoir of infection.

Age Factors↗
PubMed1999

Nipple care, sore nipples, and breastfeeding: a randomized trial.

Sore and cracked nipples are common and may represent an obstacle to successful breastfeeding. In Italy, it is customary for health professionals to prescribe some type of ointment to prevent or treat sore and cracked nipples. The efficacy of these ointments is insufficiently documented. The incidence of sore and cracked nipples was compared between mothers given routine nipple care, including an ointment (control group), and mothers instructed to avoid the use of nipple creams and other products (intervention group). Breastfeeding duration was also compared between the two groups. Eligible mothers were randomly assigned, after informed consent, to one of the two groups. No difference was found between the control (n = 96) and the intervention group (n = 123) in the incidence of sore and cracked nipples and in breastfeeding duration. However, several factors were associated with sore nipples and with breastfeeding duration. The use of a pacifier and of a feeding bottle in the hospital were both associated with sore nipples at discharge (p = 0.02 and p = 0.03, respectively). Full breastfeeding up to 4 months postpartum was significantly associated with the following early practices: breastfeeding on demand, rooming-in at least 20 hours/day, non-use of formula and pacifier, no test-weighing at each breastfeed. The incidence of sore and cracked nipples and the duration of breastfeeding were not influenced by the use of a nipple ointment. Other interventions, such as providing the mother with guidance and support on positioning and latching, and modifications of hospital practices may be more effective in reducing nipple problems.

Adult↗
PubMed1992

A clinical research perspective: look to the obvious.

The solution to nursing problems can often be found by using a combination of a naturalistic approach and traditional scientific methods. To illustrate this link, the development of a pacifier for low birth weight infants is described. The observation of fetus' thumb sucking in utero led to a broadly based literature review that suggested the idea of the thumb as an appropriate model for nonnutritive sucking. An anthropometric study was conducted to determine if the size of the thumb correlated with the size of the mouth. The correlations between the mouth and thumb further strengthened the appropriateness of the thumb as a model for a low birth weight infant pacifier.

Anthropometry↗
PubMed2003

Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss.

OBJECTIVE: Some mothers have difficulty initiating lactation even when highly motivated to breastfeed. The purpose of this study was to determine the incidence of and risk factors for suboptimal infant breastfeeding behavior (SIBB), delayed onset of lactation, and excess neonatal weight loss among mother-infant pairs in a population with high educational levels and motivation to breastfeed. METHODS: All mothers residing in Davis, California, who gave birth to a healthy, single, term infant at 1 of 5 area hospitals during the 10-month recruitment period in 1999 were invited to participate if they were willing to attempt to breastfeed exclusively for at least 1 month. Lactation guidance was provided and data were collected in the hospital (day 0) and on days 3, 5, 7, and 14. Infant breastfeeding behavior was evaluated by trained lactation consultants using the Infant Breastfeeding Assessment Tool. Onset of lactation was defined based on maternal report of changes in breast fullness. Infant weight loss was considered excessive if it was >or=10% of birth weight by day 3. RESULTS: Of the 328 eligible mothers, 280 (85%) participated in the study. The prevalence of SIBB was 49% on day 0, 22% on day 3, and 14% on day 7. SIBB was significantly associated with primiparity (days 0 and 3), cesarean section (in multiparas, day 0), flat or inverted nipples, infant status at birth (days 0 and 3), use of nonbreast milk fluids in the first 48 hours (days 3 and 7), pacifier use (day 3), stage II labor >1 hour (day 7), maternal body mass index >27 kg/m(2) (day 7) and birth weight <3600 g (day 7). Delayed onset of lactation (>72 hours) occurred in 22% of women and was associated with primiparity, cesarean section, stage II labor >1 hour, maternal body mass index >27 kg/m(2), flat or inverted nipples, and birth weight >3600 g (in primiparas). Excess weight loss occurred in 12% of infants and was associated with primiparity, long duration of labor, use of labor medications (in multiparas), and infant status at birth. The risk of excess infant weight loss was 7.1 times greater if the mother had delayed onset of lactation, and 2.6 times greater if the infant had SIBB on day 0. CONCLUSIONS: Early lactation success is strongly influenced by parity, but may also be affected by potentially modifiable factors such as delivery mode, duration of labor, labor medications, use of nonbreast milk fluids and/or pacifiers, and maternal overweight. All breastfeeding mother-infant pairs should be evaluated at 72 to 96 hours' postpartum.

Birth Weight↗
PubMed2006

Predictors of breastfeeding duration: evidence from a cohort study.

OBJECTIVE: To report the duration of breastfeeding among a population of Australian women and to identify factors that are associated with the duration of full breastfeeding to 6 months and any breastfeeding to 12 months. METHODS: Participants were 587 women who were recruited from 2 maternity hospitals in Perth and completed a baseline questionnaire just before or shortly after discharge from the hospital. Women were followed up by telephone interview at 4, 10, 16, 22, 32, 40, and 52 weeks postpartum. Data collected included sociodemographic, biomedical, hospital-related, and psychosocial factors associated with the initiation and the duration of breastfeeding. Cox's proportional hazards model was used to identify factors that were associated with the risk for discontinuing full breastfeeding before 6 months and any breastfeeding before 12 months. RESULTS: At 6 months of age, fewer than one half of infants were receiving any breast milk (45.9%), and only 12% were being fully breastfed. By 12 months, only 19.2% of infants were still receiving any breast milk. Breastfeeding duration was independently, positively associated with maternal infant feeding attitudes and negatively associated with breastfeeding difficulties in the first 4 weeks, maternal smoking, introduction of a pacifier, and early return to work. CONCLUSIONS: Relatively few women achieved the international recommendations for duration of full and overall breastfeeding. Women should receive anticipatory guidance while still in the hospital on how to prevent or manage common breastfeeding difficulties and should be discouraged from introducing a pacifier before 10 weeks, if at all. Improved maternity leave provisions and more flexible working conditions may help women to remain at home with their infants longer and/or to combine successfully breastfeeding with employment outside the home.

Attitude↗
PubMed2004

[The relationship between oral habits, oronasopharyngeal alterations, and malocclusion in preschool children in Vitória, Espírito Santo, Brazil].

The objective of this study was to estimate the prevalence of malocclusion and associated variables such as deleterious habits (DH) and oronasopharyngeal alterations (OA), mouth breathing, atypical phonation, and atypical swallowing in three-year-old children in Vitória, Espírito Santo State, Brazil. The sample included 291 children of both sexes enrolled in a Children's Educational Center and selected through probability sampling by conglomerates. Logistic regression indicated a high relative risk (RR) in children with altered overjet, open bite, and cross-bite to present mouth breathing (RR = 1.89; CI: 1.56-2.03), (RR = 2.46; CI: 2.00-3.02), (RR = 1.45; CI: 1.23-1.72); atypical swallowing (RR = 2.57; CI: 1.87-3.52), (RR = 3.49; CI: 2.53-4.81), (RR = 1.86; CI: 1.46-2.39); and atypical phonation (RR = 2.25; CI: 1.66-3.05), (RR = 3.18; CI: 2.38-4.25), (RR = 1.71; CI: 1.32-2.22), respectively. An association was shown between finger or pacifier sucking and altered overjet (p < 0.001), and between pacifier sucking and open bite (p < 0.001). Such results indicate that the prevalence of malocclusions is associated with DH and OA.

Brazil↗