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PubMed2006

The efficacy of non-pharmacological interventions in the management of procedural pain in preterm and term neonates. A systematic literature review.

BACKGROUND: Neonates in a neonatal intensive care unit are exposed to a high number of painful procedures. Since repeated and sustained pain can have consequences for the neurological and behaviour-oriented development of the newborn, the greatest attention needs to be paid to systematic pain management in neonatology. Non-pharmacological treatment methods are being increasingly discussed with regard to pain prevention and relief either alone or in combination with pharmacological treatment. AIMS: To identify effective non-pharmacological interventions with regard to procedural pain in neonates. METHODS: A literature search was conducted via the MedLine, CINAHL, Cochrane Library databases and complemented by a handsearch. The literature search covered the period from 1984 to 2004. Data were extracted according to pre-defined criteria by two independent reviewers and methodological quality was assessed. RESULTS: 13 randomised controlled studies and two meta-analyses were taken into consideration with regard to the question of current nursing practice of non-pharmacological pain management methods. The selected interventions were "non-nutritive sucking", "music", "swaddling", "positioning", "olfactory and multisensorial stimulation", "kangaroo care" and "maternal touch". There is evidence that the methods of "non-nutritive sucking", "swaddling" and "facilitated tucking" do have a pain-alleviating effect on neonates. CONCLUSIONS: Some of the non-pharmacological interventions have an evident favourable effect on pulse rate, respiration and oxygen saturation, on the reduction of motor activity, and on the excitation states after invasive measures. However, unambiguous evidence of this still remains to be presented. Further research should emphasise the use of validated pain assessment instruments for the evaluation of the pain-alleviating effect of non-pharmacological interventions.

Humans↗
PubMed2004

Oral health, sociodemographic factors, dietary and oral hygiene practices in Jordanian children.

OBJECTIVES: To investigate the association between oral health, in terms of dental caries and gingivitis, and sociodemographic factors, dental plaque, oral hygiene behaviours, infant feeding and dietary practices in 4-5-year-old Jordanian children. METHODS: Two-stage random sampling procedure was used to select children enrolled in kindergartens in Amman, Jordan. Clinical examinations were carried out by one examiner. Mothers completed questionnaires relating to sociodemographic factors, oral hygiene behaviours, infant feeding and dietary practices of the children. RESULTS: About 67% of the children had caries, 31% had dmft greater than 4 and 66% had gingivitis. Of the children who had been wholly breast-fed, 86% had been fed on demand. Mothers of children attending kindergartens with the lowest tuition fees were more likely to have breast-fed their children on demand and for more than 18 months (prolonged breast feeding) compared to those attending kindergartens with higher fees. Savory snacks were consumed by 82%, confectionery by 76% and teas with sugar by 42% of the children. Multivariate analysis showed age, dental plaque, sleeping beside the mother, use of comforters and selected dietary habits to have an independent effect on caries prevalence. Dental plaque and prolonged breast feeding exerted an independent effect on caries severity and gingivitis. The strongest association with gingivitis was dental plaque. CONCLUSIONS: In Jordan as elsewhere health promotion strategies need to be targeted to mothers from less advantaged backgrounds. Messages about infant breast feeding should emphasise that the method is beneficial to the oral health of the children if appropriately used.

Bottle Feeding↗
PubMedDate not supplied

Breast-feeding and deleterious oral habits in mouth and nose breathers.

AIM: Breast-feeding promotes several benefits in childhood, among them favoring the nasal breathing. In the present study, the relationship between breathing pattern and the history of breast-feeding and of deleterious oral habits was determined. STUDY DESIGN: clinical with transversal cohort. MATERIAL AND METHOD: The study population consisted of 62 children ranging in age from 3 years and 3 months to 6 years and 11 months who were submitted to otorhinolaryngologic evaluation to determine nasal and mouth breathers and to a speech language pathologic interview. The otorhinolaryngologic evaluation involved the following exams: anterior rhinoscopy, oroscopy and radiologic examination. The parents of the children were questioned about the form of feeding (natural and/or artificial), the duration of breast-feeding and the presence of deleterious oral habits (suction and biting). The Fisher exact test was used to compare groups regarding the presence and absence of habits and the different periods of breast-feeding. RESULTS: The breast-feeding period was longer among nasal breathers and was concentrated in the period between 3 and 6 months of age. Regarding the use of bottle, the results showed that most of the children in both groups used this type of feeding during the first years of life, with no significant difference between groups (p=0.58). There was a marked presence of deleterious oral habits among mouth breathers, with a statistically significant difference between groups regarding suction (p=0.004) and biting habits (p=0.0002). CONCLUSION: Mouth breathing children were breast-fed for a shorter period of time and had a history of deleterious oral habits compared to nose breathers.

Breast Feeding↗
PubMed2006

Dental arch diameters and relationships to oral habits.

The objective was to analyze variations in dental arch width in relation to oral habits. Maxillary and mandibular intercanine and intermolar distance were determined in relation to certain oral habits in 1297 children (ages 3 to 6 years). After an oral examination, the parents of each child completed a questionnaire about oral habits, including the use of a dummy or a bottle (or both), finger sucking, mouth breathing, breast- or bottle-feeding, and duration of these habits. Data were subjected to statistical analysis by the chi-square test for qualitative variables and analysis of variance for quantitative variables with homogeneous variances. Statistical significance was P < .05. In general, the maxillary arch was larger than the mandibular arch with regard to both the intercanine and the intermolar distances and more significantly so in boys. In relation to age, a significant increase was found only for the mandibular intercanine distance (P = .001). When arch width was analyzed in relation to various oral habits, the maxillary intercanine distance was less in children who used a dummy, especially one of a round design (P = .003). The maxillary intercanine distance was also less in children who breathed through their mouth (P = .002). In most cases, dummy use and mouth breathing were associated with a reduction in the intercanine distance in the maxillary arch. A dummy habit leads to a reduction in maxillary arch width, and mouth breathing causes a reduction in the size of both arches.

Age Factors↗
PubMed2003

Migration of N-nitrosamines, N-nitrosatable substances and 2-mercaptobenzthiazol from baby bottle teats and soothers: a Dutch retail survey.

In 2001, a retail market survey of 19 samples of teats and soothers was performed in the Netherlands. The migration of 2-mercaptobenzthiazol (MBT), N-nitrosamines and nitrosatable substances was measured. A screening was also performed for other potential migrants. Of the soothers, shield size and yield strength were determined. Most of the teats and soothers on the Dutch market were made of silicone rubber, although a few were made of natural rubber. The migration of N-nitrosamines and nitrosatable substances was far below the migration limit of 0.01 and 0.1 mg kg(-1) teat, respectively, with the exception of one natural rubber soother. For this soother, the migration of nitrosatable substances was 0.23 mg kg(-1) and measures were therefore taken against the supplier. MBT was detected in only one natural rubber sample, migration being well below the limit of 0.3 mg/teat. The extractable substances in the silicone teats and soothers are siloxanes. From the two natural rubber products, substances were extracted that were not on the positive list of the Dutch Packaging and Food-Utensils Regulation. Most of these substances are allowed in other countries, or authorized for plastic food contact materials. The size of the shields of all soothers and yield strengths were in compliance with the Regulation.

Benzothiazoles↗
PubMed2006

Unexplained infant and child death: a review of sudden infant death syndrome, sudden unexplained infant death, and child maltreatment fatalities including shaken baby syndrome.

PURPOSE OF REVIEW: This review will examine the most recent published literature on Sudden Infant Death, Sudden Unexplained Infant Death, infant and child death due to maltreatment, and Shaken Baby Syndrome. RECENT FINDINGS: New recommendations from the American Academy of Pediatrics about the evaluation and prevention of possible Sudden Infant Death Syndrome cases were published this year, with a focus not only on the Back to Sleep campaign, but other factors that may contribute to the risk of Sudden Infant Death Syndrome. Additionally, the controversial issue of bed sharing is addressed, with advice given not to bed share in the first 3 months of life. The possibility of a second sudden infant death within a family is discussed. Attention is also paid to the importance of considering inflicted injury in the differential diagnosis of every unexplained infant or child death, and the recent literature on child maltreatment deaths is reviewed. SUMMARY: The grieving family who has lost an infant should receive immediate attention and support, and a multidisciplinary investigation team should be involved as soon as possible so that a full investigation can take place. Investigation of unexplained infant or child death should always involve a thorough interview with all adults involved, as well as a proper scene investigation and post-mortem examination.

Biomechanical Phenomena↗
PubMed2006

Pattern and severity of early childhood caries.

OBJECTIVES: The aim of this study was to investigate the association between selected social and behavioural variables and the pattern and severity of early childhood caries (ECC) within a community child population. METHODS: A cross-sectional sample of 2515 children aged 4-5 years were examined in a preschool setting using decayed, missing, filled teeth/surface (dmft/dmfs) indices and a self-administered questionnaire was used to obtain information regarding social, demographic, birth, infant feeding, oral and general health attitudes. Children with caries (847) were divided into anterior or posterior caries pattern groups and severe (dmfs score > or =6) or non-severe (dmfs score <6) caries groups. The data were analysed using a chi-square test and modelled using a logistic regression procedure. RESULTS: Significant variables associated with anterior ECC pattern were ethnicity other than Caucasian (OR = 2.1, 95% CI = 1.4-3.1), sipping from the bottle during the day (OR = 1.9, 95% CI = 1.3-2.7), male gender (OR = 1.6, 95% CI = 1.2-2.2) and sleeping with a bottle at night (OR = 1.5, 95% CI = 1.1-2.2). Significant variables associated with severe ECC form were sipping from the bottle during the day (OR = 2, 95% CI = 1.4-2.8), maternal age at birth < or =24 years (OR = 1.8, 95% CI = 1.3-2.7), ethnicity other than Caucasian (OR = 1.6, 95% CI = 1.1-2.5) and sleeping with a bottle at night (OR = 1.5, 95% CI = 1.1-2.2). CONCLUSIONS: Infant bottle-feeding habits (either allowing a child to sip from a bottle during the day or put to sleep at night) and ethnicity other than Caucasian were significant determinants for both anterior caries pattern and severity of ECC in 4-5-year-old Australian children.

Adult↗
PubMed2004

Breast feeding, bottle feeding, and non-nutritive sucking; effects on occlusion in deciduous dentition.

AIMS: To assess the effect of the type of feeding and non-nutritive sucking activity on occlusion in deciduous dentition. METHODS: Retrospective study of 1130 preschool children (3-5 years of age) who had detailed infant feeding and non-nutritive sucking activity history collected by a structured questionnaire. They all had an oral examination by a dentist, blinded to different variables evaluated. RESULTS: Non-nutritive sucking activity has a substantial effect on altered occlusion, while the effect of bottle feeding is less marked. The type of feeding did not have an effect on open bite, which was associated (89% of children with open bite) with non-nutritive sucking. Posterior cross-bite was more frequent in bottle fed children and in those with non-nutritive sucking activity. The percentage of cross-bite was lower in breast fed children with non-nutritive sucking activity (5%) than in bottle fed children with non-nutritive sucking activity (13%). CONCLUSIONS: Data show that non-nutritive sucking activity rather than the type of feeding in the first months of life is the main risk factor for development of altered occlusion and open bite in deciduous dentition. Children with non-nutritive sucking activity and being bottle fed had more than double the risk of posterior cross-bite. Breast feeding seems to have a protective effect on development of posterior cross-bite in deciduous dentition.

Bottle Feeding↗
PubMed2004

Dummies.

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Attitude of Health Personnel↗
PubMed2006

Association between allergic rhinitis, bottle feeding, non-nutritive sucking habits, and malocclusion in the primary dentition.

AIM: To determine the association between allergic rhinitis, bottle feeding, non-nutritive sucking habits, and malocclusion in the primary dentition. METHODS: Data were collected on 1160 children aged 4-5 years, who had been longitudinally followed since the age of 4 months, when they were admitted to nurseries in a suburban area of Tampico-Madero, Mexico. Periodically, physical examinations were conducted and a questionnaire was given to their parents or tutors. RESULTS: Malocclusion was detected in 640 of the children (51.03% had anterior open bite and 7.5% had posterior cross-bite). Allergic rhinitis alone (adjusted odds ratio = 2.87; 95% CI 1.57 to 5.25) or together with non-nutritive sucking habits (adjusted odds ratio = 3.31; 95% CI 1.55 to 7.09) had an effect on anterior open bite. Bottle feeding alone (adjusted odds ratio = 1.95; 95% CI 1.07 to 3.54) or together with allergic rhinitis (adjusted odds ratio = 3.96; 95% CI 1.80 to 8.74) had an effect on posterior cross-bite. Posterior cross-bite was more frequent in children with allergic rhinitis and non-nutritive sucking habits (10.4%). CONCLUSIONS: Allergic rhinitis alone or together with non-nutritive sucking habits is related to anterior open bite. Non-nutritive sucking habits together with allergic rhinitis seem to be the most important factor for development of posterior open bite in children under the age of 5 years.

Bottle Feeding↗
PubMed2003

Factors relating to the infant's last sleep environment in sudden infant death syndrome in the Republic of Ireland.

AIM: To identify risk factors for sudden infant death syndrome (SIDS) in the sleeping environment of Irish infants. METHODS: A five year population based case-control study with parental interviews conducted for each case and three controls matched for age, place of birth, and last sleep period. A total of 203 SIDS cases and 622 control infants born 1994-98 were studied. RESULTS: In a multivariate analysis, co-sleeping significantly increased the risk of SIDS both as a usual practice (adjusted OR 4.31; 95% CI 1.07 to 17.37) and during the last sleep period (adjusted OR 16.47; 95% CI 3.73 to 72.75). The associated risk was dependent on maternal smoking (OR 21.84; 95% CI 2.27 to 209.89), and was not significant for infants who were > or =20 weeks of age (OR 2.63; 95% CI 0.49 to 70.10) or placed back in their own cot/bed to sleep (OR 1.07; 95% CI 0.21 to 5.41). The use of pillows, duvets, and bedding with tog value > or =10 were not significant risk factors when adjusted for the effects of confounding variables, including maternal smoking and social disadvantage. However, the prone sleeping position remains a significant SIDS risk factor, and among infants using soothers, the absence of soother use during the last sleep period also significantly increased the SIDS risk (OR 5.83; CI 2.37 to 14.36). CONCLUSION: Co-sleeping should be avoided in infants who are <20 weeks of age, or whose mothers smoked during pregnancy. The prone position remains a factor in some SIDS deaths, and the relation between soother use and SIDS is a complex variable requiring further study.

Beds↗
PubMed2004

Effect of bottles, cups, and dummies on breast feeding in preterm infants: a randomised controlled trial.

OBJECTIVE: To determine the effect of artificial teats (bottle and dummy) and cups on breast feeding in preterm infants. DESIGN: Randomised controlled trial. SETTING: Two large tertiary hospitals, 54 peripheral hospitals. PARTICIPANTS: 319 preterm infants (born at 23-33 weeks' gestation) randomly assigned to one of four groups: cup/no dummy (n = 89), cup/dummy (n = 72), bottle/no dummy (n = 73), bottle/dummy (n = 85). Women with singleton or twin infants < 34 weeks' gestation who wanted to breastfeed were eligible to participate. INTERVENTIONS: Cup or bottle feeding occurred when the mother was unable to be present to breast feed. Infants randomised to the dummy groups received a dummy on entry into the trial. MAIN OUTCOME MEASURES: Full breast feeding (compared with partial and none) and any breast feeding (compared with none) on discharge home. SECONDARY OUTCOMES: prevalence of breast feeding at three and six months after discharge and length of hospital stay. RESULTS: 303 infants (and 278 mothers) were included in the intention to treat analysis. There were no significant differences for any of the study outcomes according to use of a dummy. Infants randomised to cup feeds were more likely to be fully breast fed on discharge home (odds ratio 1.73, 95% confidence interval 1.04 to 2.88, P = 0.03), but had a longer length of stay (hazard ratio 0.71, 0.55 to 0.92, P = 0.01). CONCLUSIONS: Dummies do not affect breast feeding in preterm infants. Cup feeding significantly increases the likelihood that the baby will be fully breast fed at discharge home, but has no effect on any breast feeding and increases the length of hospital stay.

Adult↗