Breastfeeding self-efficacy of women using second-line strategies for healthy term infants in the first week postpartum : an Australian observational study

Background Breastfeeding self-efficacy (BFSE) supports breastfeeding initiation and duration. Challenges to breastfeeding may undermine BFSE, but second-line strategies including nipple shields, syringe, cup, supply line and bottle feeding may support breastfeeding until challenges are resolved. The primary aim of this study was to examine BFSE in a sample of women using second-line strategies for feeding healthy term infants in the first week postpartum. Methods A retrospective self-report study was conducted using the Breastfeeding Self-Efficacy Scale - Short Form (BSES-SF), demographic and infant feeding questionnaires. Breastfeeding women who gave birth to a singleton healthy term infant at one private metropolitan birthing facility in Australia from November 2008 to February 2009 returned anonymous questionnaires by mail. Results A total of 128 (73 multiparous, 55 primiparous) women participated in the study. The mean BSES-SF score was 51.18 (Standard deviation, SD: 12.48). The median BSES-SF score was 53. Of women using a second-line strategy, 16 exceeded the median, and 42 were below. Analyses using Kruskal-Wallis tests confirmed this difference was statistically significant (H = 21.569, p = 0.001). The rate of second-line strategy use was 48%. The four most commonly used second-line strategies were: bottles with regular teats (77%); syringe feeding (44%); bottles with wide teats (34%); and nipple shields (27%). Seven key challenges were identified that contributed to the decision to use second-line strategies, including: nipple pain (40%); unsettled infant (40%); insufficient milk supply (37%); fatigue (37%); night nursery care (25%); infant weight loss > 10% (24%); and maternal birth associated pain (20%). Skin-to-skin contact at birth was commonly reported (93%). At seven days postpartum 124 women (97%) were continuing to breastfeed. Conclusions The high rate of use of second-line strategies identified in this study and high rate of breastfeeding at day seven despite lower BFSE indicate that such practices should not be overlooked by health professionals. The design of this study does not enable determination of cause-effect relationships to identify factors which contribute to use of second-line strategies. Nevertheless, the significantly lower BSES-SF score of women using a second-line strategy highlights this group of women have particular needs that require attention.

The nutritional management of acute diarrhea in young infants : effect of carbohydrate ingested

To compare the efficacy of a low-lactose hy-drolyzed milk formula, a lactose-free corn syrup-based milk formula, and a standard lactose-containing formula during refeeding after rehydration in infants with gastroenteritis, 135 patients older than 2 years were studied by randomized trial. Clearly demonstrated disadvantages in terms of early weight loss and longer duration of diarrhea were observed with the lactose-based formula compared with early weight gains on both the low-lactose formulae, and thus the lactose-containing formula was discontinued after 91 patients. The early weight loss with the lactose-containing formula was statistically significantly related to the degree of relative (rehydrated) underweight. The two low-lactose formulae were further compared in the remaining 44 patients. Early weight gain (48 h) was sig-nificantly greater with the lactose-hydrolyzed formula compared with the corn syrup-based formula, but no statistically significant differences were observed in duration of diarrhea, energy intake, treatment failures, or late weight gain. We conclude that the routine use of a low-lactose formula during refeeding after rehydration in infants with gastroenteritis may have some advantages in underweight infants and toddlers in whom it is important to prevent further weight loss. © 1994 Raven Press Ltd, New York.

Early Childhood Caries and a Community Trial of its Prevention in Tehran, Iran

Varhaislapsuuden karies ja sen ehkäisy kehittyvän terveydenhuollon maassa Varhaislapsuuden karies on merkittävä kansanterveysongelma varsinkin lapsirikkaissa maissa ja väestöissä. Karieksen hoitaminen vie paljon voimavaroja ja aiheuttaa mittavia taloudellisia seuraamuksia. Karies voi ilmaantua lapselle jo vauvaikäisenä, pian ensimmäisten maitohampaiden puhjettua suuhun. Alle 3-vuotiaiden karieksesta on kuitenkin niukasti tilastotietoja. Maailman terveysjärjestökin suosittaa tietojen keräämistä vasta 3-vuotiaiden ikäryhmästä. Heistä kariesta sairastaa Suomessa 16 %, Yhdysvalloissa 25 %, Englannissa 30 %, Iranissa 46 % ja Saudi-Arabiassa 61 %. Tämä väitöstutkimus selvitti karieksen esiintymistä ja sen vaaratekijöitä 1─3-vuotiailla Teheranissa. Lisäksi tutkimus arvioi perusterveydenhuoltoon sisällytetyn karieksen ehkäisyn tuloksellisuutta. Tutkimuskohteiksi arvottiin Teheranista 18 neuvolaa. Jokaisessa oltiin 4 päivää, jolloin kaikkia rokotuksiin tulleita 1─3-vuotiaita äiteineen pyydettiin osallistumaan tutkimukseen. Kahta lukuun ottamatta kaikki äidit suostuivat, ja aineistoon tuli kaikkiaan 504 lasta äiteineen. Kaikki 1-vuotiaat, 242 lasta äiteineen, valittiin karieksen ehkäisykokeiluun. Sitä varten neuvolat jaettiin kolmeen ryhmään, joista kaksi (A ja B) oli koeryhmiä ja yksi (C) oli vertailuryhmä. Tutkimus alkoi äidin haastattelulla. Siinä selvitettiin perheen koulutus- ja tulotaso sekä lapsen ruokinnasta imetyksen kesto, yösyötöt ja päiväaikaan nautitut makeat. Vielä kysyttiin lapsen ja äidin suuhygieniatavoista ja äidin kokemuksista lapsen suun puhdistamisessa. Sitten hammaslääkäri tutki lapsen suun ja kirjasi karieksen ja hammasplakin esiintymät. Suun tutkimuksen jälkeen äiti ja lapsi siirtyivät rokotushuoneeseen. Koeryhmissä (A ja B) äidit saivat terveydenhoitajalta suunterveyttä koskevan esitteen ja kehotuksen lukea se huolellisesti. Lisäksi ryhmässä A terveydenhoitaja kertoi suun ja hampaiden terveydenhoidosta saman esitteen avulla, ja neuvolan henkilökunta muistutti suunhoidon tärkeydestä puhelimitse kahdesti seuraavan puolen vuoden kuluessa. Vertailuryhmässä äideille ei annettu suunhoidon ohjeita. Kaikissa ryhmissä äitejä muistutettiin seuraavan rokotuskerran ajankohdasta, muttei mainittu tulevaa toista hammastarkastusta. Varhaislapsuuden kariesta sairasti ikäryhmästä riippuen 3─26 % tutkituista 1─3-vuotiaista, ja 65─76 %:lla oli hammasplakkia. Äideistä 68 % harjasi hampaansa päivittäin ja 39 % puhdisti lapsensa suun päivittäin. Mitä useammin äiti harjasi omat hampaansa, sitä paremmin hän huolehti lapsen suun puhtaudesta. Rintaruokinta oli yleistä eikä lisännyt kariesvaaraa. Yöllä pullomaitoa saavilla karies oli 5 kertaa yleisempää kuin muilla. Neuvolassa saatu ohjeistus ehkäisi selvästi karieksen syntyä puolen vuoden kokeessa.

”Waxaa i bartay hooyaday waawa u muhiim naaska caruurta.” Äitini opetti, että rintamaito on tärkeää lapselle. Osallistava tutkimus auktoritatiivisen tiedon omaksumisesta somalikulttuuritaustaisten naisten imetyskäytännöissä.

Suomessa asuvat somalitaustaiset maahanmuuttajaäidit luopuvat imetyksestä ja ruokkivat vauvojaan äidinmaidonkorvikkeella, vaikka somalikulttuurissa arvostetaan imetystä. Tuen ja tiedon puutetta on arveltu syyksi pulloruokinnan yleisyyteen. Tarkoituksenani on tutkia osallistavia menetelmiä käyttäen, minkälaisia imetykseen liittyviä tietojärjestelmiä somaliäidit pitävät auktoritatiivisina eli arvovaltaisina. Tarkastelen tiedon auktoritatiivisuutta etnografisten esimerkkien valossa hyödyntäen Brigitte Jordanin auktoritatiivisen tiedon käsitettä. Tutkin Jean Pierre Olivier de Sardanin teorian avulla, kuinka paikalliset populaarit tietojärjestelmät kohtaavat tieteellis-teknisen tiedon kehityksen kontekstissa. Tutkin myös, kuinka somaliäitien imetystietojärjestelmät kohtaavat suomalaisen terveydenhoitojärjestelmän edustaman imetystiedon. Osallistavien menetelmien tarkoituksena on saada heikkojen ja sorrettujen yhteisöjen ääni kuuluviin. Tutkimukseni tiedonantajina on seitsemäntoista somalimaahanmuuttajaäitiä ja yksi suomalainen äitiys- ja lastenneuvolan terveydenhoitaja. Käytän tiedonkeruumenetelminä puolistrukturoituja teemahaastatteluja, jonka lisäksi teen osallistuvaa havainnointia ja osallistavia menetelmiä kolmessa ryhmähaastattelutilanteessa. Käytän Rapi Rurad Appraisal (RRA) –menetelmiä, kuten Venn-diagrammia ja pisteytystä. Tutkimukseni tulos on, että somaliäitien imetykseen liittyvä tieto koostuu kolmesta tietojärjestelmästä, joita ovat sukuverkostoista tuleva perinteinen tietotaito, islaminuskon terveystieto sekä suomalaisen terveydenhoitojärjestelmän tieto. Näistä eri tietolähteistä tuleva imetystieto ei ole sisällöltään ristiriidassa. Imetykseen liittyvät vaikeudet ovat käytännön ongelmiin, kuten sukuverkoston hajoamiseen ja suomalaisen terveydenhoitojärjestelmän kanssa kommunikointiin liittyviä.

Rede e apoio social e práticas alimentares de crianças no quarto mês de vida

Cerca de 97% das crianças brasileiras iniciam a amamentação ao peito nas primeiras horas de vida. No entanto, o início do desmame é precoce, ocorrendo nas primeiras semanas ou meses de vida, com a introdução de água, chás, sucos, outros leites e alimentos. Fatores sociais, culturais, psicológicos e econômicos, ligados à mãe e ao bebê, podem estar relacionados a variações das práticas alimentares de crianças nos primeiros meses de vida. O objetivo do trabalho foi investigar a associação entre rede e apoio social e as práticas alimentares de lactentes no quarto mês de vida. Foi feito um estudo seccional inserido em uma coorte prospectiva, tendo como população fonte recém-nascidos acolhidos em Unidades Básicas de Saúde da Secretaria Municipal de Saúde do Rio de Janeiro. Para avaliar as práticas alimentares foi aplicado às mães (n=313) um recordatório 24h adaptado e foram construídos dois indicadores considerando o consumo de alimentos sólidos e da alimentação láctea. Para medir rede social foram feitas perguntas relacionadas ao número de parentes e amigos com quem a mulher pode contar e à participação em atividades sociais em grupo. Para aferir apoio social foi utilizada uma escala utilizada no Medical Outcomes Study (MOS) e adaptada para uso no Brasil. A análise dos dados se baseou em modelos de regressão logística multinomial, estimando-se razões de chance e respectivos intervalos de 95% de confiança para as associações entre as variáveis. Observou-se 16% dos lactentes em aleitamento materno exclusivo (AME), 18,8% em aleitamento materno predominante (AMP), aproximadamente 48% em uso de leite materno associado a outros alimentos e 16,5% em aleitamento artificial. Em relação ao aleitamento complementar, 25,9% consumiam alimentos sólidos e 37,5% alimentos lácteos. Crianças filhas de mães que referiram menor número de parentes com quem contar e com baixo apoio social apresentaram maior chance de estar em aleitamento artificial em relação ao AME, quando comparadas com filhas de mães que referiram poder contar com parentes ou com nível alto de apoio social. O baixo apoio social nas dimensões emocional/informação apresentou associação com AMP. Tendo em vista os achados apresentados, destaca-se a necessidade de integrar os membros da rede social da mulher à atenção pré-natal, ao parto e puerpério de modo que esta rede possa prover o apoio social que atenda as suas necessidades e, assim, contribuir para iniciação e manutenção do AME.

Neonatal control of sucking pressures

Human newborns appear to regulate sucking pressure when bottle feeding by employing, with similar precision, the same principle of control evidenced by adults in skilled behavior, such as reaching (Lee et al., 1998a). In particular, the present study of 12 full-term newborn infants indicated that the intraoral sucking pressures followed an internal dynamic prototype - an intrinsic tau-guide. The intrinsic tau-guide, a recent hypothesis of general tau theory is a time-varying quantity, tau(g), assumed to be generated within the nervous system. It corresponds to some quantity (e.g., electrical charge), chang ing with a constant second-order temporal derivative from a rest level to a goal level, in the sense that tau(g) equals tau of the gap between the quantity and its goal level at each time t. (tau of a gap is the rime-to-closure of the gap at the current closure-rate.) According to the hypoth esis, the infant senses tau(p), the tau of the gap between the current intraoral pressure and its goal level, and regulates intraoral pressure so that tau(p) and tau(g) remain coupled in a constant ratio, k; i.e., tau(p) = k tau(g). With k in the range 0-1, the tau-coupling would result in a bell-shaped rate of change pressure profile, as was, in fact, found. More specifically, the high mean r(2) values obtained when regressing tau(p) on tau(g), for both the increasing and decreasing suction periods of the infants' suck, supported a strong tau-coupling between tau(p) and tau(g). The mean k values were significantly higher In the Increasing suction period, indicating that the ending of the movement was more forceful, a finding which makes sense given the different functions of the two periods of the suck.

Relação entre desenvolvimento motor corporal e aquisição de habilidades orais

TEMA: a literatura aponta para a influência da postura corporal sobre as habilidades orais em crianças com desenvolvimento sensório-motor alterado. em crianças normais existem poucos estudos sobre essa relação. OBJETIVO: estudar em crianças a termo a relação entre habilidades motoras e habilidades motoras orais, desde 1 dia de vida até 24 meses de idade. MÉTODO: 42 crianças foram filmadas com 1 dia, 1 mês, 2, 3, 4, 5, 6, 9,12 e 24 meses nas posições supino, prono, sentado e em pé e durante alimentação com amamentação / mamadeira (até 5 meses), uso de colher para alimentação pastosa (3 aos 12 meses), uso de copo para água ou suco (6 aos 24 meses) e alimento sólido (6 aos 24 meses). Estabeleceram-se escores de quantificação para o desenvolvimento corporal e habilidades orais e utilizou-se o coeficiente de correlação de Pearson para o estudo estatístico, adotando-se nível de significância de 5%. RESULTADOS: os resultados do desenvolvimento motor apontaram para semelhança de dados entre supino e prono e sentado e em pé; para as habilidades orais (durante a alimentação com mamadeira/amamentação, colher, copo, mastigação) constatou-se em cada modalidade de alimentação, homogeneidade de aquisição de habilidades para lábios, língua e mandíbula. Houve associação entre habilidades motoras e orais; resultados apontam que o desenvolvimento motor (habilidades motoras) se deu antes das orais desde o 5° ao 24° mês e que as habilidades de mandíbula em copo e colher ocorreram antes das habilidades de lábios e língua. CONCLUSÃO: houve crescente aquisição de habilidades motoras e orais, variabilidade de habilidades em idades entre 3 e 24 meses e associação entre habilidades motoras e orais.

Métodos de alimentação alternativos para recém-nascidos prematuros

OBJETIVO: Apresentar revisão de literatura sobre o uso do copo/xícara como método alternativo de alimentação para recém-nascidos prematuros e verificar se há consenso sobre sua indicação para essa população. FONTES DE DADOS: Revisão de literatura narrativa, tendo sido selecionados artigos nas bases de dados Medline, Lilacs, SciELO e Cochrane, independentemente do ano, usando descritores específicos: alimentação artificial, recém-nascido prematuro, aleitamento materno, métodos de alimentação. SÍNTESE DOS DADOS: Apesar de alguns estudos afirmarem que o método do copo/xícara é eficaz e seguro para alimentar recém-nascidos pré-termo e a termo, tais estudos não avaliam de forma objetiva o efeito do método sobre a deglutição desses pacientes. CONCLUSÕES: Verificou-se não haver consenso na literatura quanto à complementação da alimentação de recém-nascidos prematuros por meio do copo/xícara. Estudos controlados devem ser realizados com a finalidade de rever riscos e benefícios do uso de métodos alternativos na alimentação do recém-nascido prematuro.

Caries experience associated to social and preventive factors in children of a pastoral community from Limeira-SP

Aim: To evaluate caries experience and prevalence associated to social and preventive factors in 3-6-year-old children of a Pastoral Community from Limeira, Brazil. Methods: A cross-sectional study was carried out through an epidemiologic research about the oral conditions of 110 children registered at the Children's Pastoral Community from the city of Limeira, SP, Brazil. Intraoral examination was performed by a trained dentist and the parents/caregivers filled out a questionnaire in order to outline the children's profile with respect to gender, parental education and oral health. Results: Differences related to gender were not detected (p= 0.3404). The most frequent periods of breastfeeding were 0 to 2 months (36.36%) and 2 to 6 months (35.45%), corresponding to 71.81% of the cases. The time bottle feeding pointed to two most frequent categories: 1) more than 12 months (35.45%) and 2) between 2 and 6 months (22.63%). Regarding parental education, the majority of the sample has not completed primary school (38.32%). It was observed a larger number of decayed teeth in male children (63.39%). Caries experience was significantly higher in children who were breastfed for only 2 months of life (41.96%). Children that did not use baby bottle or did not use a baby bottle for more than 1 year presented a smaller dmft, corresponding to 29.17% and 28.33%, respectively. Time of use of bottle and pacifier presented a significant association (p<0.05). Conclusions: The implementation of adequate strategies and actions is needed to reinforce oral health conditions in risk groups.

Avaliação eletromiográfica dos músculos masseter, temporal e bucinador de lactentes em situação de aleitamento natural e artificial

Pós-graduação em Pediatria - FMB

Longitudinal study of habits leading to malocclusion development in childhood

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Extrinsic causes of erosion. Behavioral factors

During and after an erosive challenge, behavioral factors play a role in modifying the extent of erosive tooth wear. The manner that dietary acids are introduced into the mouth (gulping, sipping, use of a straw) will affect how long the teeth are in contact with the erosive challenge. The frequency and duration of exposure to an erosive agent is of paramount importance. Night-time exposure (e.g. baby bottle-feeding) to erosive agents may be particularly destructive because of the absence of salivary flow. Health-conscious individuals tend to ingest acidic drinks and juices more frequently and tend to have higher than average oral hygiene. While good oral hygiene is of proven value in the prevention of periodontal disease and dental caries, frequent toothbrushing with abrasive oral hygiene products may enhance erosive tooth wear. Unhealthy lifestyles such as consumption of designer drugs, alcopops and alcohol abuse are other important behavioral factors.

Maternal nutrition and oral health factors in early childhood caries

Background. Early Childhood Caries (ECC) is the most common chronic infectious disease of childhood worldwide. Seven of ten American children have one or more decayed or filled primary teeth by age five. ECC prevalence is especially high in lower socio-economic ethnic populations. Commonly recognized as a diet-induced disease, focal etiological factors include cariogenic bacteria, fermentable carbohydrates, and a susceptible newly erupted tooth. Sequencing of breast and/or bottle feeding and introduction of beikost come at a time when children's defense mechanisms and, perhaps maternal direction of children's dietary patterns, are not yet fully developed or mature. To date, most research has examined biological factors, while maternal factors, especially psychosocial ones, have received scant attention. Objective. To examine the association of psychosocial factors in terms of maternal nutrition and oral health knowledge, attitudes, and beliefs, as well as social support and self-efficacy (KABS2) in a population of socio-economically disadvantaged infants and young children. A secondary aim was to describe ECC prevalence in this population. Methods. This study examined cross-sectionally the relationship between selected maternal psychosocial variables and ECC in a convenience sample of Mexican-American women and very young children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in San Antonio, Texas. Mothers were surveyed by use of a criteria- and content-valid, reliable questionnaire, and dental examinations were conducted on 191 children, aged 5 to 47 months old. Results. Thirty-nine percent of the children had ECC. As assessed on a 30-question scale, women in whose children were diagnosed with ECC were found to demonstrate lower Knowledge ( p=0.03), Attitudes (p=0.02), Beliefs (p=0.04), and Social Support (p<0.01) scores, compared to women whose children were found to be caries-free. No differences in Self-Efficacy scores were found between the groups. Conclusions. These data indicate that current etiological model depicting relevant factors associated with ECC in Mexican-American infants and children of low socio-economic status should be broadened to include consideration of maternal psychosocial factors such as nutrition and oral health knowledge, attitudes, beliefs, and social support, and that these factors should be considered when planning educational approaches to reduce the occurrence of ECC. ^

Madres y enfermeras: el modelo de cuidados a la infancia en la colección «Al servicio de España y del niño español» (1938-1964)

Objetivos: El estudio se plantea profundizar en el análisis del discurso del régimen franquista que se dirigió a la población femenina, especialmente a las madres y a las enfermeras, en relación con los cuidados a la infancia. Métodos: Se analizó la colección «Al Servicio de España y del Niño Español» (1938-1964), publicada por el Ministerio de Gobernación, mediante un análisis del contenido de las monografías que se ocupaban del los cuidados a la infancia. Discusión y conclusiones: El régimen franquista condenó el trabajo fuera del hogar de las mujeres y promovió una política pronatalista. Las mujeres fueron consideradas ignorantes y por tanto culpables de la elevada mortalidad infantil. Su acción se orientó a capacitar a todas las mujeres (que algún día llegarían a ser madres) en el cuidado de los niños. Fue obligatoria la enseñanza de la puericultura a las niñas en todos los niveles. Se fomento la lactancia materna con un discurso culpabilizador (la mujer que no lacta es una semimadre). Con todo, a pesar de todas estas iniciativas pronatalistas, la realidad social se impuso y la natalidad disminuyó, y también lo hizo la mortalidad infantil debido a la mejora de las condiciones de vida, al mismo tiempo que se produjo un fuerte aumento del uso del biberón y del trabajo femenino fuera del hogar.

Global standard for the composition of infant formula: Recommendations of an ESPGHAN coordinated international expert group

The Codex Alimentarius Commission of the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) develops food standards, guidelines and related texts for protecting consumer health and ensuring fair trade practices globally. The major part of the world's population lives in more than 160 countries that are members of the Codex Alimentarius. The Codex Standard on Infant Formula was adopted in 1981 based on scientific knowledge available in the 1970s and is currently being revised. As part of this process, the Codex Committee on Nutrition and Foods for Special Dietary Uses asked the ESPGHAN Committee on Nutrition to initiate a consultation process with the international scientific community to provide a proposal on nutrient levels in infant formulae, based on scientific analysis and taking into account existing scientific reports on the subject. ESPGHAN accepted the request and, in collaboration with its sister societies in the Federation of International Societies on Pediatric Gastroenterology, Hepatology and Nutrition, invited highly qualified experts in the area of infant nutrition to form an International Expert Group (IEG) to review the issues raised. The group arrived at recommendations on the compositional requirements for a global infant formula standard which are reported here.