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PubMed2003

The effect of music-reinforced nonnutritive sucking on feeding rate of premature infants.

Premature infants are fed by gavage tube before 34 weeks adjusted gestational age and when nipple feeding results in detrimental changes in respiration and heart rate. Nipple feeding skill must be developed and correlates with length of hospitalization and neurobehavioral development. This study provided music reinforcement for nonnutritive sucking and assessed nipple feeding rates pre- and posttreatment for 32 infants referred as poor feeders. A pacifier fitted with a pressure transducer activated 10 seconds of recorded music in a one-trial, 15-minute intervention given to experimental infants (n = 16) 30 to 60 minutes before the late afternoon bottle feeding. Feeding rates were collected for bottle feedings pre- and postintervention and for a similar interval for a no-contact control group (n = 16). Results showed that the intervention significantly increased feeding rates. Music functioned as reinforcement and the sucking behavior transferred from a nonnutritive to a nutritive event.

Feeding Behavior↗
PubMed2005

Relationship between oral parafunctional/nutritive sucking habits and temporomandibular joint dysfunction in primary dentition.

UNLABELLED: The aim of this study was to evaluate the relationship between nutritive and parafunctional habits and the presence of temporomandibular dysfunction (TMD) in children with primary dentition. METHODS: Ninety nine children, aged 3-5 years, were examined to check for the presence or absence of signs and symptoms of TMD (headache, preauricular pain, earache, masticatory muscle tenderness, deviation on opening, occlusal interference and asymmetric movement of the mandible), oral parafunctions (bruxism, nail biting, finger/thumb sucking, speech alteration, mouth breathing, pacifier and atypical swallowing) and nutritive habits (breast- or bottle-feeding) through interview and clinical examination. The results were submitted to descriptive statistical analysis and Fisher's exact test. RESULTS: The results showed that only atypical swallowing was positively related to TMD (P < 0.0001); other oral parafunctional and nutritive habits were not related to TMD. CONCLUSIONS: It was concluded that parafunctional habits, with the exception of atypical swallowing, and feeding methods were not determinants for the presence of signs and/or symptoms of TMD in the sample of children included in the study.

Bottle Feeding↗
PubMed2005

"Binkie flutter," an apparently voluntary behavior of infants, possibly related to vibratory jaw movements in dogs: report of 4 cases.

Four cases of apparently voluntary rapid vibratory pacifier movements occurring in normal, unstressed infants up to 1 year of age and captured on video are presented. I speculate on the possible relationship of the movements to similar vibratory jaw movements in dogs, in which species they may represent a neuromuscular mechanism for rapid feedback control.

Female↗
PubMed2005

The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk.

There has been a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992 that infants be placed down for sleep in a nonprone position. Although the SIDS rate continues to fall, some of the recent decrease of the last several years may be a result of coding shifts to other causes of unexpected infant deaths. Since the AAP published its last statement on SIDS in 2000, several issues have become relevant, including the significant risk of side sleeping position; the AAP no longer recognizes side sleeping as a reasonable alternative to fully supine sleeping. The AAP also stresses the need to avoid redundant soft bedding and soft objects in the infant's sleeping environment, the hazards of adults sleeping with an infant in the same bed, the SIDS risk reduction associated with having infants sleep in the same room as adults and with using pacifiers at the time of sleep, the importance of educating secondary caregivers and neonatology practitioners on the importance of "back to sleep," and strategies to reduce the incidence of positional plagiocephaly associated with supine positioning. This statement reviews the evidence associated with these and other SIDS-related issues and proposes new recommendations for further reducing SIDS risk.

Beds↗
PubMed2006

Feeding-facilitating techniques for the nursing infant with Robin sequence.

OBJECTIVE: To determine the effectiveness of feeding-facilitating techniques in children with Robin sequence. SETTING: Hospital de Reabilitação de Anomalias Craniofaciais, University of São Paulo, Bauru, São Paulo, Brazil. PATIENTS: Twenty-six children less than 2 months of age with Robin sequence, whose only cause of respiratory obstruction was glossoptosis. Thirteen infants were treated by being placed in the prone position (Group 1), and 13 were treated by nasopharyngeal intubation (Group 2). INTERVENTIONS: During hospitalization, the following feeding-facilitating techniques were applied daily to all children: pacifier, massage to relax and anteriorize the tongue, long and soft bottle nipple with original or enlarged hole, global symmetric position, rhythmic movement of the nipple during suction, and insertion of the nipple on the tongue. RESULTS: During the first evaluation, Group 1 patients accepted 36.15 +/- 33.05 mL milk orally within a period of 44.62 +/- 42.94 minutes, whereas Group 2 ingested 20.00 +/- 20.51 mL milk within 30.38 +/- 25.77 minutes. A significant increase (p < .01) in the volume of ingested milk was observed for the two groups at hospital discharge after a mean treatment period of 10.7 days (Group 1: 63.46 +/- 22.58 mL and Group 2: 55.00 +/- 13.07 mL). The mean duration of feeding decreased in the two groups, with a value of 21.54 +/- 7.18 minutes for Group 1 and of 20.28 +/- 8.53 minutes for Group 2. CONCLUSION: The results showed that feeding-facilitating techniques can foster oral feeding in infants with Robin sequence.

Airway Obstruction↗
PubMed2004

[Common problems during lactation and their management].

OBJECTIVE: To present an updated review on common problems associated with breastfeeding and their management. SOURCE OF DATA: A comprehensive bibliographic review on the issue was performed by searching publications from the MEDLINE database and from national and international organizations. Books and some key articles cited in other sources were also selected. SUMMARY OF THE FINDINGS: Several common problems that may arise during the breastfeeding period, such as breast engorgement, plugged milk duct, breast infection and insufficient milk supply, originate from conditions that lead the mother to inadequate empty the breasts. Incorrect techniques, not frequent breastfeeding and breastfeeding on scheduled times, pacifiers and food suppliers are important risk factors that can predispose to lactation problems. The adequate management of those conditions is fundamental, as if not treated they frequently lead to early weaning. There are specific measures that should be taken to empty the breasts effectively. Besides, the emotional support and actions that yield more comfort to the lactating mother can not be neglected. CONCLUSIONS: Most common problems associated with breastfeeding can be prevented if the mother empties her breasts effectively. If they occur, they should be carefully and adequately approached, thus avoiding the early weaning resultant from painful and stressing situations the mother may face.

Bottle Feeding↗
PubMed2004

Prevalence of oral mucosal alterations in children from 0 to 12 years old.

BACKGROUND: As the exact prevalence of oral alterations in children is still not known and the findings are controversial, other studies about this subject are necessary. METHODS: A cross-sectional survey was carried out on 1211 Brazilian children divided in two age groups: 0-4 and 5-12 years. The patients were economically classified and data of medical history were obtained from medical records. RESULTS: The frequency of children presenting alterations was 27.0%, and it was higher in older children. The most common lesions were geographic tongue, cheek biting, and melanotic macule. Candidiasis was associated with antibiotic therapy and use of pacifiers. Fissured tongue was associated with congenital anomalies, allergy; age from 5 to 12 years. There was a lack of association of patient's economic status and prevalence of oral mucosal alterations. CONCLUSIONS: The frequency of mucosal alterations in children is high and increases with age, and some of them are associated with habits and medical history of the patients.

Age Factors↗
PubMedDate not supplied

[Promotion of breastfeeding: the importance of pediatricians with specific training].

OBJECTIVE: To study the factors involved in the maintenance of exclusive breastfeeding in healthy infants during the first 4 months of life, with emphasis on the role of pediatricians. MATERIAL AND METHODS: A longitudinal study was carried out with 101 healthy term babies at a pediatrics outpatient clinic in Uberaba, state of Minas Gerais, Brazil. The babies were divided at random into three groups: G1, receiving advice from a multiprofessional breastfeeding team; G2, receiving advice from a pediatrician trained in breastfeeding; and G3, receiving advice from a pediatrician with no breastfeeding training. Group randomization was confirmed by analysis of variance. The factors involved in the type of feeding at 4 months were analyzed by the chi-square test, by analysis of variance and by multiple variable analysis. RESULTS: At the end of follow-up, Groups 1 and 2 showed similar percentages with respect to exclusive breastfeeding. In addition, the percentage of exclusively breastfed babies in Groups 1 and 2 was significantly higher than in Group 3 (p = 0.002). The use of a pacifier was negatively correlated with exclusive breastfeeding (p = 0.003). More maternal schooling increased the chance of exclusive breastfeeding at 4 months (p = 0.041). CONCLUSIONS: In this study, a pediatrician who was prepared and motivated to encourage breastfeeding performed similarly to a multiprofessional breastfeeding team in terms of promoting exclusive breastfeeding until 4 months.

Brazil↗
PubMed2004

[Effects of nonnutritive sucking on gastric emptying and gastroesophageal reflux in premature infants].

OBJECTIVE: Although nonnutritive sucking (NNS) during tube feeding has some benefits on the physiology and development of premature infants, the effect on gastrointestinal function remains controversial. The aim of the study was to evaluate the effects of NNS on the gastric emptying and gastroesophageal reflux (GER) in premature infants. METHODS: Thirty eight healthy appropriate-for-gestational-age premature infants (birth weight ranged from 1050 g to 1790 g, gestational age ranged from 28 weeks to 35 weeks) accepting intermittent nasogastric feeding (INGF) were randomized into NNS group and N-NNS group according to INGF with and without NNS and fed with the same milk formula. Group NNS (n = 18) received oral stimulation by means of a pacifier immediately before feeding, during feeding and then after feeding for 5 min. Group N-NNS (n = 20) served as control and received INGF alone. The following data were collected and recorded, the fluid intake (including both intravenous and oral), milk intake, caloric intake, time of caloric intake reaching 418.4 kJ/(kg x d) by enteral feeding and relevant condition to feeding. Gastric emptying was measured when oral intake reaching above 8 ml/kg while concurrently measuring 24 hour esophageal pH. Real time ultrasonic images of the gastric antrum were obtained and the antral cross sectional area (ACSA) was measured and the half emptying time (50% DeltaACSA) was calculated. Using 24-hour intraesophageal pH monitoring for evaluation of GER, the five parameters of esophageal pH were recorded: number of reflux episodes during 24 hours, reflux index, number of episodes lasting > 5 min, the duration of longest episode and the total time of pH < 4.0. RESULTS: Within two weeks after feeding, there was no significant difference in the fluid intake, caloric intake between the two groups (P > 0.05). Gastric emptying was measured on day 13.26, milk intake had no difference between the two groups and there was no difference in prefeed ACSA. The half gastric emptying time in NNS group was significantly shorter than that in N-NNS group [(58.33 +/- 22.94) min vs. (73.75 +/- 17.76) min, P < 0.05]. Thirty-two of the 38 infants developed GER, the morbidity was 84.2%; the number of reflux episodes during 24 hours was significantly fewer in NNS group than that in N-NNS group [9 (2 - 31) vs. 14 (5 - 31), P < 0.05]; the total time pH < 4.0 and reflux index was lower in NNS than that in N-NNS, but the difference was not statistically significant. The time of reaching 418.4 kJ/(kg x d) by enteral feeding in NNS group was significantly shorter than that in N-NNS group [(12.36 +/- 4.29) d vs. (15.50 +/- 4.58) d, P < 0.05]. The incidence of feeding intolerance such as vomiting and abdominal distension was lower in NNS group than that in N-NNS group, but the difference was not statistically significant (P > 0.05). However, the morbidity of gastric residue in NNS was significantly lower than that in N-NNS (16.7% vs 50.0%, respectively, P < 0.05). CONCLUSION: NNS used during intermittent nasogastric tube feeding is an easy and safe intervention. NNS can improve gastric emptying and decrease the number of reflux episodes, has a positive improving effect on the development of gastrointestinal motility, is beneficial to premature infants for establishing postnatal enteral nutrition.

Enteral Nutrition↗
PubMedDate not supplied

Effects of nonnutritive sucking habits on occlusal characteristics in the mixed dentition.

PURPOSE: Little is known about the extent to which nonnutritive sucking habits contribute to malocclusion in the mixed dentition. The purpose of this study was to report on the relationship between certain occlusal traits in the mixed dentition and longitudinal sucking behaviors. METHODS: Dental examinations were conducted on 630 children in the mixed dentition who participated in a large, ongoing longitudinal study. Five hundred eighty consented to impressions, and 524 adequate study models were obtained. Of these, 444 also had adequate longitudinal nonnutritive sucking data obtained via mailed questionnaires to parents at 3- to 6-month intervals from birth to 8 years. Sucking behaviors were grouped by predominant type and duration. Study models were hand articulated using wax bites to evaluate the occlusion for the presence of open bite, crossbite, molar relationship, and excessive overjet. Bivariate statistical analyses related presence of these malocclusions to sucking duration and type. RESULTS: Fifty-five percent of the children had malocclusions (anterior open bite, posterior crossbite, bilateral Class II molar relationship, or overjet >4 mm). Class II molar relationship was most common (30%). Overall, anterior open bite and posterior crossbite was associated with habits of 36 months or more. Sustained pacifier habits, including those of 24 to 47 months, were associated with anterior open bite and Class II molar relationships, while digit habits were associated with anterior open bite when sustained for 60 months or longer. CONCLUSIONS: Malocclusions are quite prevalent in the mixed dentition, and anterior open bite and posterior crossbite may be preventable by modifying nonnutritive sucking behaviors.

Chi-Square Distribution↗
PubMedDate not supplied

Association of maternal-child characteristics as a factor in early childhood caries and salivary bacterial counts.

UNLABELLED: The aim of this study was to investigate the caries-related microorganisms in saliva and the prevalence of Early childhood caries (ECC) in 15- to 35-month-old Turkish children and their associations with the characteristics of the mothers, socioeconomic criteria, and feeding habits of the children. METHODS: Saliva samples of 101 children were studied to determine the numbers of Streptococcus mutans, lactobacilli, and Candida albicans. A questionnaire regarding the characteristics of the mothers, socioeconomic criteria, and feeding habits of the children was carried out before the dental examinations of the mother-child pairs. RESULTS: The regression analyses revealed DMFS scores of the mothers as an impact factor for the children's caries experience. The prolonged usage of feeding bottle with sweetened milk, pacifier use, and maternal sharing were strongly associated with the colonization of S. mutans, lactobacilli, and C. albicans, respectively. A significant correlation was also found between maternal education and S. mutans. CONCLUSION: Data indicated that the mother's DMFS scores, education, and feeding habits were strong risk indicators for the colonization of caries-related micro-organisms and ECC.

Adult↗
PubMed2006

SIDS-protective infant care practices among Auckland, New Zealand mothers.

AIM: To survey the knowledge and implementation of sudden infant death syndrome (SIDS)-protective infant care practices in mothers of infants aged less than 4 months. METHODS: A postal survey was carried out of knowledge of SIDS risk factors and infant care practices of 200 mothers with infants aged 6-8 weeks and 3-4 months. RESULTS: Mothers who could cite supine sleeping as protective comprised 84%, while 73% knew that smoking was a risk factor. Fewer knew that room sharing, keeping the face clear of bedding, and avoiding bed sharing and overheating are also protective. Fifty-four percent of the infants usually room-share with a parent, while 39% both room-share and sleep in their own bed. Sixteen percent usually co-slept for part or all of the night. Nearly one-third used pacifiers. Mothers who smoked during pregnancy comprised 8%, while 7% had smoked in the last 24 hours. Most infants (97%) had been breastfed at some time. CONCLUSIONS: Maternal education of the benefits of supine sleeping, not smoking, and breastfeeding appear well understood by these mothers. However, more education is needed about other SIDS-protective behaviours such as keeping the face clear and sleeping the infant in their own bed in the parents' room.

Adult↗
PubMed2006

A comparative study of nonpharmacological methods to reduce pain in neonates.

A randomized study was done to compare non pharmacological methods to reduce the pain of heel pricks in 104 stable term neonates. Non-nutritive sucking (NNS), rocking, massage, sucrose (20 percent), distilled water (DW) and expressed breast milk (EBM) were used as pain reducing agents. Duration of cry and Douleur Aiguë du Nouveau né (DAN) score were used to assess pain. Physiological parameters were also recorded before and after the stimulus. At 30 seconds after the stimulus, the pain scores were lowest in the sucrose group but this was not sustained at 1, 2 and 4 minutes. At 2 and 4 minutes pain scores were lowest in the NNS and rocking groups as compared to sucrose, distilled water, expressed breast milk and massage. The total duration of crying was also lowest in the NNS and rocking groups. Physiological parameters were comparable in all groups. Babies who were in Prechtl State 1 and 2 (sleeping) at the time of stimulus showed significantly lesser response to pain compared to babies who were awake. This was seen in all the intervention groups. In conclusion, our study suggests that rocking or giving a baby a pacifier are more effective non-pharmacological analgesics than EBM, DW, sucrose or massage for the pain of heel pricks in neonates. A calm or sleeping state before a painful procedure also appears to decrease crying and pain scores.

Analgesia↗
PubMed2000

Combined analgesia and local anesthesia to minimize pain during circumcision.

BACKGROUND: Pain of circumcision is only partially relieved by single modalities, such as penile nerve block, lidocaine-prilocaine cream, and sucrose pacifiers. OBJECTIVE: To assess the effectiveness of a combination of interventions on the pain response of infants undergoing circumcision. METHODS: Cohort study. Group 1 included infants circumcised using the Mogen clamp and combined analgesics (lidocaine dorsal penile nerve block, lidocaine-prilocaine, acetaminophen, and sugar-coated gauze dipped in grape juice). Group 2 included infants circumcised using the Gomco clamp and lidocaine-prilocaine. Infants were videotaped during circumcision, and pain was assessed using facial activity scores and percentage of time spent crying. RESULTS: There were 57 infants in group 1 and 29 infants in group 2. Birth characteristics did not differ between groups. Infants in group 1 were older than infants in group 2 (17 days vs 2 days) (P < .001). The mean duration of the procedure was 55 seconds and 577 seconds for infants in group 1 and 2, respectively (P < .001). Facial action scores and percentage of time spent crying were significantly lower during circumcision for infants in group 1 (P < .001). The percentage of time spent crying was 18% and 40% for infants in groups 1 and 2, respectively. No adverse effects were observed in infants in group 1; 1 infant in group 2 had a local skin infection. CONCLUSIONS: Infants circumcised with the Mogen clamp and combined analgesia have substantially less pain than those circumcised with the Gomco clamp and lidocaine-prilocaine cream. Because of the immense pain during circumcision, combined local anesthesia and analgesia using the Mogen clamp should be considered.

Acetaminophen↗
PubMed2003

Effective pain reduction for multiple immunization injections in young infants.

BACKGROUND: Infants experience undue pain with multiple immunization injections. OBJECTIVE: To assess the effectiveness, feasibility, and parental acceptance of a simple combination pain reduction intervention for infants receiving multiple immunization injections. DESIGN: Randomized, controlled, clinical trial. SETTING: Academic hospital-based primary care center. PARTICIPANTS: Infants receiving their 2-month immunizations, consisting of 4 injections (diphtheria and tetanus toxoids and acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenzae b conjugate and hepatitis B vaccine [Comvax], and heptavalent pneumococcal conjugate vaccine [Prevnar]). INTERVENTIONS: Subjects were randomly assigned to the intervention or control group for administration of 4 injections. The intervention group received sucrose and oral tactile stimulation (with a pacifier or a bottle) and were held by their parents during immunization. The control group did not receive these interventions (standard practice). MAIN OUTCOME MEASURES: Blinded assessment of audiotaped crying, heart rate, parent preference for future use of the injection technique, and nurse-rated ease of vaccine administration. RESULTS: One hundred sixteen infants (mean +/- SD age, 9.5 +/- 2.0 weeks) participated. The median (25th-75th percentile range) first cry duration was 19.0 (5.8-62.8) seconds for the intervention group compared with 57.5 (31.0-81.5) seconds for the control group (P =.002). Parents of the intervention group reported a stronger preference for future use of the injection procedure. For intervention vs control, the median (25th-75th percentile) parent preference visual analog scale score was 97.0 (82.0-100.0) vs 44.0 (5.0-77.2) (P<.001) (100 indicates definitely prefer). Nurse-rated ease of vaccine administration was equivalent for both treatment groups. CONCLUSIONS: Combining sucrose, oral tactile stimulation, and parental holding was associated with significantly reduced crying in infants receiving multiple immunization injections. Parents stated a strong preference for future use of this method, and nurses found the intervention injection technique easy to apply.

Administration, Oral↗
PubMed1996

Utility of a risk assessment questionnaire in identifying children with lead exposure.

OBJECTIVE: To evaluate the utility of the Centers for Disease Control and Prevention (CDC) Risk Questionnaire and a behavioral risk factor questionnaire in identifying children with blood lead concentrations of 0.48 mumol/L (10 micrograms/dL) or more. DESIGN: Cross-sectional study of 463 urban Massachusetts children (6 to 72 months of age) screened for lead with venous blood. RESULTS: Twenty-two percent of the children had elevated blood lead concentrations. Of the five CDC questions, only one was significantly associated with an increased adjusted odds ratio for elevated blood lead: having a sibling, housemate, or playmate who was followed up or treated for lead poisoning (odds ratio, 2.7; 95% confidence interval, 1.7 to 4.2; P < .001). Children who had at least one positive or equivocal response to any of the five CDC questions (n = 318 [68.7%]) were not at higher risk than were children who displayed a negative response to all five questions (odds ratio, 1.1; 95% confidence interval, 0.7 to 1.8; P = .69). Of nine behaviors surveyed, two were associated with an increased adjusted odds for elevated blood lead: use of a pacifier (odds ratio, 2.4; 95% confidence interval, 1.3 to 4.4; P = .01) and playing near the outside of the home (odds ratio, 3.4; 95% confidence interval, 2.0 to 5.8; P < .001). CONCLUSIONS: In this population of children, the CDC risk questionnaire did not identify a group at higher risk for lead exposure. We suggest that practitioners in urban communities screen all children according to the same schedule. We conclude that risk factors differ by community and no risk questionnaire developed at the national level should be applied across communities to target screening.

Centers for Disease Control and Prevention, U.S.↗
PubMed1975

A congenital contribution to emotional response in early infancy and the preschool period.

Four follow-up studies carried out from the newborn period in three different laboratories have shown that a slow, low-magnitude reaction of the newborn to interruption of sucking is associated in later infancy and the preschool period with the expression of pleasurable emotional response. The basic test of the newborn's response varied slightly in the four studies, but essentially it consisted of establishing a baseline of infant behaviour during 30 to 120 seconds of sucking on a pacifier, then recording amount of (a) bodily activity, (b) crying, (c) the latency to either or both, in the 30- to 135-second period after removal of the nipple. The three aspects of the reaction are consistently intercorrelated, even when allowances are made for artifactual interdependence. Newborns who respond quickly to interruption of sucking also continue to cry and move a lot. Up to the first month a slow, low-magnitude reaction of the newborn is associated with a later low rate of smiling, but beyond the third month there is an inversion and the association is consistently with various manifestations of postive emotional expression.

Age Factors↗
PubMed1992

Blood pressure increases in response to feeding in the term neonate.

We studied blood pressure and heart rate of 18 medically well newborn babies before, during, and after feeding. Seven were breast-fed and 11 bottle-fed and all were studied between 24 and 92 hr of age. There was an increase in heart rate associated with sucking on a pacifier but no additional increase with feeding. By 30-60 min after feeding, heart rate had returned to baseline value. Blood pressure, however, did increase in response to feeding and showed a greater increase in the breast-fed group than in the bottle-fed group. Systolic blood pressure rose from 72 mmHg in the basal state to 85 mmHg during the first 3 min of feeding in the bottle-fed babies and from 73 to 99 mmHg during comparable periods in the breast-fed babies. The results for diastolic blood pressure were similar except that changes within the bottle-fed group were not statistically significant. Bottle-fed babies rose only from 42 to 47 mmHg while breast-fed babies rose from 42 to 61 mmHg from basal conditions to feeding. Blood pressure responses to feeding may have implications for susceptibility to necrotizing enterocolitis, for future blood pressure liability in adulthood and for later hypertensive disease.

Arousal↗