The Influence of the First Thousand Days of Life on Establishing Determinant Behaviors for Dental Caries in Childhood

ABSTRACT Objective: To study the influence of the first thousand days of life on establishing determinant behaviors for dental caries in childhood. Material and Methods: Longitudinal retrospective study involving 664 children born in 2009 living in a southern Brazilian municipality was carried out. Data was collected through interviews with mothers and through child's health card. Dependent variables were 1) tooth brushing onset after two years of age; 2) absent tooth brushing or once a day; 3) tooth brushing without adult supervision; 4) not having gone to the dentist until the age of 6; and 5) seek for dental services due to toothache at 6 years of age, over the last 30 days. Bivariate and multivariate analyses were performed using Poisson Regression to estimate relative risks (RR) and respective confidence intervals at the 95% accuracy level. Results: Mothers with lower schooling at child's birth presented a higher risk of "child's tooth brushing onset only after two years of age", "brushing the teeth once a day only or not brushing" and with "child not having gone to the dentist until the age of 6". Mothers who did not have a job when the child was born were associated with "not having gone to the dentist until the age 6". Children with gastroesophageal reflux who underwent hospitalization for more than 2 days under age 2 were associated with "seeking dental services because of pain at 6 years of age over the last 30 days". Conclusion: Higher risks of some determinant behaviors related to dental caries were associated with variables of the period of the first thousand days of life.

Interactive behaviors between mothers and their prematurely born infants in the face-to-face Still-Face Paradigm / Relações entre os comportamentos interativos maternos e de bebês prematuros no contexto do Face-to-Face Still-Face

The present study compared and correlated interactive behaviors of 15 mothers and their very preterm infants (gestational age: 28-32 weeks). Mothers and infants were observed in the experimental Face-to-Face Still-Face paradigm, consisting of three episodes: in the first and third episodes (play and reunion episodes), mother and infant interact freely; in the second (still-face episode), the mother maintains a still-face expression. The behaviors of the infants were allocated in three categories: positive social orientation, negative social orientation and self-regulation. Maternal behaviors were classified into positive and negative social orientation. Intragroup comparisons indicated that maternal vocalizations were significantly higher in the play episode. Compared to other studies with preterm infants, babies in this study exhibit fewer interactive behaviors and more self-soothing behaviors in the still-face episode. In addition, in the reunion episode, values of the behaviors presented in the play episode were recovered. Correlations between intrusive maternal behaviors and noninteractive or negative-interaction behaviors of the infant suggest the relevance of providing intervention to promote maternal sensitivity.

O presente estudo buscou comparar e descrever a correlação entre comportamentos interativos de quinze mães e seus bebês nascidos muito prematuros (idade gestacional: 28-32 semanas). As díades foram observadas com base no paradigma experimental do Face-to-Face Still-Face, composto por três episódios: nos Episódios 1 e 3 mãe e bebê interagem e, no Episódio 2, a mãe mantém-se inexpressiva. Os comportamentos dos bebês foram analisados conforme três categorias: orientação social positiva, orientação social negativa e autorregulação. Os comportamentos maternos foram classificados em orientação social positiva e negativa. Comparações intragrupo apontaram que as vocalizações maternas foram significativamente maiores no Episódio 1. Comparativamente a outros estudos com prematuros, os bebês deste estudo apresentaram menos comportamentos interativos e mais comportamentos de autoconforto no Episódio 2. No Episódio 3 os comportamentos interativos, tanto das mães quanto dos bebês, recuperaram as frequências apresentadas no Episódio 1. As correlações entre comportamentos maternos intrusivos e comportamentos não interativos ou de interação negativa com o bebê sugerem a relevância de se oferecerem intervenções para promover a sensibilidade materna.

Effect of object weight and experience on the organization of object management tasks in infants of 10 months of age / Efeito do peso de objetos e da experiência na organização de tarefas de manipulação de objetos de bebês de 10 meses de idade

INTRODUCTION: CLittle is known about the real impact the practice of manipulating objects on the development of infants perception-action and it is assumed that this newly acquired knowledge is useful for planning future actions. OBJECTIVE: To analyse the effects of controlled practice on the tasks of reaching and transporting objects in 10-month-old infants when the weight of the object was changed. METHODS: Sixteen infants were divided into two groups: heavy/light group (HLG) and light/heavy group (LHG). The task consisted in reaching, grasping, and lifting a lighter or heavier bar 9 times. On the tenth trial, the object weight was switched to the heavier or lighter weight object (whichever was opposite to the object weight experienced in the first 9 trials) to assess whether infants had learned and adapted their object-directed movement strength to the initial weight condition practiced during the first 9 trials. RESULTS: No significant differences were found when comparing the reaching and lifting phases within groups (LHG, P = 0.06 and HLG, p = 0.41). However, group comparisons revealed that HLG infants presented increased velocity peak (p = 0.01) during the trials CONCLUSION: The reaching and object lifting trials of the infants throughout the attempts were very variable, indicating that, possibly, at 10 months of age, infants present transitions from one organizational state to another. However, it is necessary to carry out more detailed investigations on reaching and lifting actions of objects to understand the processes involved in these transition periods.

INTRODUÇÃO: Pouco se sabe sobre o impacto real da prática de manipulação de objetos no desenvolvimento da percepção-ação de bebês e assume-se que esse conhecimento recém-adquirido é útil para planejar ações futuras. OBJETIVO: O objetivo deste estudo foi investigar o efeito da prática controlada nas tarefas de alcançar e transportar objetos de crianças de 10 meses de idade quando o peso do objeto é alterado. MÉTODO: Dezesseis lactentes foram divididos em dois grupos: grupo pesado / leve (GPL) e grupo leve / pesado (GLP). A tarefa consistia em alcançar, apreender e levantar uma barra leve ou pesada por 9 tentativas. Na décima tentativa, o peso do objeto foi trocado para o objeto mais pesado ou mais leve (objeto com o peso oposto do utilizado nas 9 primeiras tentativas) para avaliar se os bebês aprenderam e adaptaram o movimento direcionado ao objeto com peso inicial da condição praticada durante as 9 primeiras tentativas. RESULTADOS: Não foram encontradas diferenças significativas quando comparado às fases de alcance e levantamento dentro dos grupos (GPL, p= 0,41 e GLP, p= 0,06), entretanto, na comparação entre os grupos, o GPL aumentou o pico de velocidade (p= 0,01) durante as tentativas. CONCLUSÃO: Concluímos que o alcance e levantamento de objeto do bebê ao longo das tentativas é muito variável. Isso indica que, possivelmente, aos 10 meses de idade, o bebê apresenta transições de um estado organizacional para outro. No entanto, é necessário realizar investigações mais detalhadas sobre as ações de alcance e levantamento de objetos para entender os processos envolvidos nesses períodos de transição.

Observação do comportamento neonatal: adaptação transcultural do newborn behavioral observations / Observation of neonatal behavior: cross-cultural adaptation of the newborn behavioral observations

RESUMO Objetivo: Realizar a adaptação transcultural para a língua portuguesa brasileira dos protocolos do sistema Newborn Behavioral Observations (NBO), novo recurso para observação do comportamento do bebê e compartilhamento de informações com os pais. Métodos: Estudo metodológico de tradução e adaptação transcultural do sistema NBO, que inclui o Formulário de Registro, com 18 itens, o Guia de Registro, com instruções para pontuação de cada item, o Sumário para os Pais, para registro de sugestões e orientações decorrentes da observação, e o Questionário de Pais, para avaliação da experiência. Foram seguidas as recomendações internacionais para adaptação transcultural de protocolos da área de saúde, o que incluiu solicitação de autorização para tradução aos autores, tradução, retrotradução e pré-teste, seguido de avaliação externa por painel de especialistas, que avaliou a qualidade da adaptação de cada item, com cálculo do índice de concordância entre os avaliadores quanto à equivalência conceitual e cultural. Resultados: A avaliação do painel de especialistas evidenciou que a versão adaptada transculturalmente do sistema NBO foi bem compreendida conceitualmente e adequada culturalmente, com 140 (77,8%) itens apresentando índice de concordância maior que 90% quanto à equivalência conceitual e cultural. Itens que não obtiveram níveis adequados de concordância foram revisados conforme sugestões dos especialistas. Conclusões: A versão brasileira do sistema NBO pode ser utilizada com segurança, já que a metodologia empregada foi rigorosa, garantindo equivalência entre o original e a tradução. O sistema NBO está pronto para ser usado clinicamente, podendo contribuir para a melhora de qualidade da assistência materno-infantil.

ABSTRACT Objective: To conduct the cross-cultural adaptation for Brazilian Portuguese of the Newborn Behavioral Observations (NBO), a new resource for observing neonatal behavior and sharing information with parents. Methods: Methodological study of translation and cultural adaptation of the NBO system, which includes the Recording Form, with 18 items, the Recording Guidelines, with instructions to score each item, the Summary Form, to record suggestions based on the observation, and the Parent Questionnaire, to record the parents' experiences. The adaptation process followed international recommendations for cross-cultural adaptation of health care protocols, which included requesting permission from the authors, translation, back translation and pre-test, followed by external evaluators who scored the quality of the adaptation, which was analyzed quantitatively. The quality of the adaptation of the instruments' items was evaluated by the index of agreement between evaluators for conceptual and cultural equivalence. Results: Expert panel evaluation showed that the cross-cultural adaptation of the NBO protocols was both well understood conceptually and culturally appropriate, with 140 (77.8%) items presenting concordance index higher than 90% for conceptual and cultural equivalence. Items that did not reach adequate level of agreement were revised according to experts' suggestions. Conclusions: The Brazilian version of the NBO system can be safely used, since the methodology was rigorous enough to ensure equivalence between the original and translated versions. The NBO should be tried in clinical practice, as it can contribute to improve the quality of maternal and child care.

Effect of kangaroo mother care on breastfeeding andbehavior of full-term newborn / 中国实用护理杂志

Objective To explore the effect of kangaroo mother care(KMC)on breastfeeding, behavior,body temperature and weight of full-term newborn. Methods A total of 80 full-term newborns from March to December of 2017 were selected by the convenience sampling method, and were randomly divided into control group and intervention group, with 40 cases each group. Routine obstetric nursing was provided for the newborns in the control group. In addition,one hour of KMC was provided for the newborns in the intervention group. The LATCH scores, neonatal behaviors, body temperature and weight were observed on daily basis. Meanwhile, an interview was conducted to investigate mothers′attitudes towards KMC. Results The LATCH scores of the intervention group for the second and third days were respectively (6.52±0.81) and (7.75±1.08), which were higher than that in control group (5.95±0.95), (7.02± 1.07). The differences were statistically significant (t=2.887,3.010,P<0.05). The behavioral status of neonates in the intervention group for 3 days was (3.65±1.12), (3.42±0.87), (3.35±1.07), all of which were lower than that in control group (4.57 ± 0.98), (4.50 ± 1.24), (4.65 ± 1.27), and the differences were statistically significant (t=-4.593,-8.285,-7.029, P<0.01). The interviews showed that 100.0％(40/40) of mothers were satisfied with KMC and were very happy in the process.95.0％(38/40)of mothers believe that KMC can increase mother-child relationships.82.5％(33/40)of mothers believe that KMC can keep children quiet.72.5％(29/40)of mothers feel that KMC can relieve pain in the abdomen or perineum. Conclusions In the hospital, 1h of KMC can make breastfeeding more effective and the newborn condition is more stable, which is worthy of clinical application.

Effects of mother-infant early skin-to-skin contact with different duration on neonatal behavior and breast-feeding / 中国医师杂志

Objective To investigate the effects of mother-infant early skin-to-skin contact with different duration on neonatal behavior and breast-feeding.Methods 80 infants born from January 2017 to June were selected and randomly divided into observation group and control group,40 cases in each group.The two groups were given early maternal and infant skin contact after birth.The observation group lasted for 1 hour,while the control group lasted until the perineal wound was sutured,with an average of (30.75 ± 1.13) minutes.Comparisons were made between the two groups in terms of crying within 0-1 h,5-6 h after birth,neonatal behavioral score (BNBAS) at 11 min and 119 min after birth,breastfeeding at the first and 6 weeks and 6 months after delivery.Results At 0-1 h,5-6 h after birth,the number and duration of crying in the observation group were significantly less than those in the control group,and the BNBAS score at 119 min was significantly lower than that in the control group (P ＜ 0.05).The score of breast feeding measurement tool in the observation group was (10.45 ± 2.22) at the time of first feeding,which was significantly higher than that in the control group (8.08 ± 1.61) (P ＜0.05).The rate of exclusive breastfeeding in the observation group was 72.5％ and 52.5％ at 6 weeks and 6 months postpartum,which was significantly higher than that in the control group (37.5％ and 17.5％,P ＜ 0.05).Conclusions 1 hour of mother-infant early skin-to-skin contact can reduce awakening and cry of infant,improve the effect of breast-feeding.

Iron Supplement in Paroxysmal Non-epileptic Events in Children

PURPOSE: Paroxysmal non-epileptic event (PNE) is a common seizure-like symptom in children. With regard to therapy, a decrease in iron levels was reported in breath-holding spells, but not in other PNEs. The effects of iron supplementation were investigated on various PNEs. METHODS: Medical records of patients who visited our clinic with seizure-like symptoms were retrospectively reviewed at Chungnam National University Hospital, from March 2013 to March 2016. RESULTS: A total of 29 patients (65.9%) were boys and 15 (34.1%) were girls. The mean gestational age and birth weight were 39.3 weeks and 3,200 g, respectively. The mean age at the time of visit was 23.5 months. Of the 11 patients who underwent brain imaging, 10 (90.9%) had normal findings and 1 (9.1%) had subdural hemorrhage. An electroencephalogram was performed in 29 patients; 26 of them had normal findings (89.7%), 2 (6.9%) had slow background, and 1 (3.4%) had epileptiform discharges. A total of 31 patients (70.5%) had iron levels lower than 80 µg/dL. Iron supplementation was administered in 4 of the 13 patients with normal iron status and in 21 of the 31 patients with low iron status. A significant improvement in the frequency and severity of symptom was observed in 91.7% of patients who received iron supplementation (P<0.05). CONCLUSIONS: Symptoms improved in 80% of patients with PNE, and a higher rate of symptom improvement could be expected with iron supplementation.

Audiometria de reforço visual em lactentes nascidos a termo e pré-termo: nível mínimo de resposta / Visual reinforcement audiometry in infants who born term and pre-term: minimum response level / Audiometría de refuerzo visual en infantes nacidos a término y pre ­ término: nivel mínimo de respuesta

Objetivo: analisar os Níveis Mínimos de Respostas (nmrs) em lactentes, nascidos a termo e pré-termo e investigar a relação entre os nmrs e os diferentes Indicadores de Risco para Deficiência Auditiva (irdas). Método: a amostra foi composta por 114 lactentes que apresentaram resultado "passa" na Triagem Auditiva Neonatal (TAN), de seis a oito meses de idade, distribuídos em dois grupos conforme a idade gestacional. Grupo Termo: 75 lactentes. Grupo Pré-termo: 39 lactentes. Realizou-se a Audiometria de Reforço Visual (ARV) com o audiômetro pediátrico, buscando os nmrs. Resultados: não houve diferença estatisticamente significante entre NMR em relação ao lado de apresentação. Os nmrs em 2 khz e 4 khz no Grupo Termo foram menores nos bebês do gênero feminino. Ao comparar nmrs dos dois grupos, não houve diferença estatisticamente significante. Os maiores nmrs apareceram entre os lactentes que apresentaram os seguintes IRDA: permanência na Unidade de Terapia Intensiva (UTI), uso de medicação ototóxica, ventilação mecânica e uso de fumo pela mãe durante o período gestacional. Conclusão: não houve diferença estatisticamente significante nos nmrs em relação ao lado de apresentação dos estímulos e entre os grupos. Observou-se que os lactentes do gênero feminino, do Grupo Termo, apresentaram menores nmrs nas frequências de 2KHz e 4KHz. Alguns irdas influenciaram no desempenho dos lactentes na ARV.

Objective: To analyze the Minimum Response Level (MRL) in infants, born term and preterm, considering some variables. In addition, to investigate the relationship between MRL and different Risk Indicators for Hearing Loss (RIHL). Methods: The sample consisted of 114 infants who had result "pass" in Newborn Hearing screening, from six to eight months old, distributed into two groups according to gestational age. Term group: 75 infants and Pre-term group: 39 infants. The Visual Reinforcement Audiometry (VRA) was made with a pediatric audiometer, seeking the MRL. Results: There was no statistically significant difference in the MRL regarding the side of the presentation. The MRL's in 2 khz and 4 khz in the Term Group were lower in female babies. Comparing the MRL between the two groups there was not statistically significant difference. The higher MRL's are among the infants with the following RIHL: Intensive care unit (ICU) hospitalization, use of ototoxic drugs, mechanical ventilation and tobacco use by the mother during pregnancy. Conclusion: There was no statistically significant difference in the MRL regarding the side of the presentation of the stimuli and between groups. It was observed that the female infants of the term group had lower mrls in the frequencies of 2KHz and 4KHz. Some RIHL influenced the performance of infants in the VRA.

Evaluar los Nivel Mínimo de Respuesta(NMRs) en infantes, nacidos a término y pretérmino, teniendo en cuenta algunas variables. Además de investigar la relación entre el NMR y diferentes indicadores de riesgo para la pérdida auditiva(IRPAs). Metodos: La muestra fue constituida por 114 infantes que aprobaran el la Screeening Auditivo para Recién (SARN), com seis a ocho meses, divididos en dos grupos según la edad gestacional. Grupo Término: 75 infantes y Grupo pre-término: 39 infantes. La Audiometría de Refuerzo Visual (ARV) se realizó con el audiómetro pediátrico, buscando el NMR. Resultados: No hubo diferencia estadísticamente significativa entre NMR en relación al lado de la presentación. El NMR en 2 KHz y 4 KHz en el Grupo Término fueron inferiores en bebés de sexo femenino. Al comparar el NMR entre los dos grupos no hubo diferencia estadísticamente significativa. Los infantes que presentaron los IRPA: estancia en la unidad de terapia intensiva (UTI), el uso de medicamentos ototóxicos, la ventilación mecánica y el uso de tabaco por la madre durante el embarazo presentaron mayor NMRs. Conclusión: No hubo diferencia estadísticamente significativa en los NMRs en relación al lado de la presentación de los estímulos y entre los grupos. Se observó que los infantes del sexo femenino del Grupo Término tenían NMRs más bajos en la frecuencia de 2 KHz y 4 KHz. Algunos IRPAs influyen en el rendimiento de los infantes en la ARV.

Early prognostic value of qualitative general movements assessment for motor development outcomes in neonatal purulent meningitis / 中华围产医学杂志

Objective To study the predictive validity of general movements (GMs) assessment for motor development outcomes in neonatal purulent meningitis.Methods According to the inclusion criteria,excluding other cerebral injury diseases,a total of 34 cases of neonatal purulent meningitis,who took part in our follow-up clinic after discharged from neonatal intensive care unit of the Second Affiliated Hospital of Wenzhou Medical University from December 2012 to December 2013,were confirmed as the participants.Infants' GMs recordings during writhing movements period (at least once at 0-3 months) and fidgety movements period (at least once at 3-5 months) were collected and assessed.Motor development outcomes was determined at least after one year old with Alberta Infant Motor Scale(AIMS).Predictive validity in each period were calculated with AIMS results as the golden standard.Results Among the 34 cases,there were 24 males and ten females,and four preterm infants and 30 term babies.The age at follow-up was from 12 months to 23 months old.Ultimately,one (3％) infant with spastic cerebral palsy,seven (21％) with motor retardation and 26 (76％) with normal motor development were diagnosed.The sensitivity,specificity,positive predictive value,negative predictive value,Youden index and residual error rate for the writhing movements period in prediction of motor development outcomes were 87.5％,46.2％,33.3％,95.6％,33.7％ and 12.5％,respectively.And the corresponding figures for the fidgety movements period were 87.5％,88.5％,70.0％,95.8％,76.0％ and 12.5％,respectively.Conclusions GMs assessment could be an accurate predictive tool for later motor developmental outcomes in neonates with purulent meningitis,especially in fidgety movements period.

Depression during gestation in adolescent mothers interferes with neonatal neurobehavior

Objective: To compare the neurobehavior of neonates born to adolescent mothers with and without depression during gestation. Methods: This prospective cross-sectional study included healthy term neonates born to adolescent mothers with untreated depression during gestation, without exposure to legal or illicit drugs, and compared them with infants born to adolescent mothers without psychiatric disorders. Maternal psychiatric diagnoses were assessed by the Composite International Diagnostic Interview (CIDI 2.1) and neonatal neurobehavior by the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) at 24 to 72 hours of life. Neurobehavioral outcomes were analyzed by ANOVA adjusted for confounders. Results: 37 infants born to mothers with depression during gestation were compared to 332 infants born to mothers without psychiatric disorders. Infants of mothers with depression had smaller head circumferences. Significant interactions of maternal depression and male gender, gestational age > 40 weeks, regional anesthesia during delivery, vaginal delivery, and infant head circumference ≥ 34 cm were found. Worse performance was noted in the following neonatal neurobehavioral parameters: arousal, excitability, lethargy, hypotonicity, and signs of stress and abstinence. Conclusion: Infants born to adolescent mothers with depression exhibit some behavioral changes in the first days of life. These changes are associated with infant sex, gestational age, type of anesthesia, mode of delivery, and head circumference. .

Análise das condições materno-gestacionais, neonatais e do desenvolvimento motor de lactentes prematuros / Analysis of maternal-gestational and neonatal conditions and motor development of premature infants

O maior risco para nascimento prematuro pode advir de fatores maternos e gestacionais. O lactente prematuro está predisposto a alterações no desenvolvimento neuropsicomotor, decorrentes de sua imaturidade e baixo peso. Neste estudo as características maternas, gestacionais e de saúde foram correlacionadas com o desenvolvimento motor de lactentes pré-termo. A análise foi transversal observacional, aprovada pelo Comitê de Ética. Os lactentes (n=15) foram avaliados aos três meses de idade corrigida utilizando a Alberta Infant Motor Scale (AIMS). Houve correlação moderada (r=-0,5750, p<0,01) entre a idade materna e o percentil da AIMS; assim, os filhos de mães adultas jovens tiveram melhor percentual (>25%). Os meninos (n=8) obtiveram significativo desempenho (r=0,5714, p<0,0001). Todas as crianças com prematuridade limítrofe atingiram percentil acima de 25%. O perfil socioeconômico foi concordante com a literatura, assim como os dados neonatais correlacionados com a AIMS. Lactentes com três meses de idade corrigida, em diferentes semanas apresentaram pontuações diferentes; quanto maior a prematuridade, menores os escores da AIMS. Neonatos prematuros devem ser acompanhados em serviços de triagem, a fim de identificar precocemente desvios da normalidade...

Recém-nascido pequeno para a idade gestacional: repercussão nas habilidades motoras finas / Small-for-gestational-age newborn infant: repercussion on fine motor skills

OBJETIVO: Comparar as habilidades motoras finas de lactentes nascidos a termo pequenos para a idade gestacional (PIG) com as habilidades dos nascidos adequados para a idade gestacional (AIG) no terceiro mês de vida. MÉTODOS: Realizou-se um estudo observacional de corte transversal. Avaliaram-se 67 lactentes (21 PIG e 46 AIG) no terceiro mês de vida. Portadores de síndromes genéticas, malformações congênitas, infecções congênitas e aqueles que necessitaram de unidade de terapia intensiva neonatal foram excluídos. As Escalas Bayley II de Desenvolvimento Infantil foram utilizadas, com ênfase nos itens que avaliam as habilidades motoras finas. RESULTADOS: Não se observaram diferenças entre os grupos na escala motora (p=0,21) e mental (p=0,45) no terceiro mês de vida. No item "Alcança o Aro Suspenso", houve diferença significativa (teste Exato de Fisher; p=0,02), demonstrando maior frequência de execução para o grupo PIG no terceiro mês de vida. CONCLUSÕES: Supõe-se que a diferença encontrada no item "Alcança o Aro Suspenso" possa ser atribuída à grande ocorrência de movimentos dos braços observada no grupo PIG e não a uma condição melhor de desenvolvimento desse grupo.

OBJECTIVE: To compare the fine motor skills of full-term small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) infants in the third month of life. METHODS: This observational cross-sectional study enrolled 67 infants (21 SGA and 46 AGA) in the third month of life. Infants presenting genetic syndromes, congenital malformations, congenital infections and those who needed neonatal intensive care were excluded. The Bayley Scales of Infant Development-II were used, with emphasis on items that evaluate the fine motor skills. RESULTS: No differences were observed between groups for motor (p=0.21) and mental (p=0.45) scales in the third month. There was a significant difference between the groups on the item "Reaches for Suspended Ring" (Fisher's exact test; p-value=0.02): a higher percentage of SGA infants accomplished this item in the third month of life. CONCLUSIONS: We hypothesize that the difference found in the item "Reaches for Suspended Ring" could be attributed to an increased frequency of arm movements observed in SGA infants and not to a better neurodevelopment of this group.

OBJETIVO: Comparar las habilidades motoras finas de lactantes nacidos a término pequeños para la edad gestacional (PEG) con adecuados para la edad gestacional (AEG) en el 3er mes de vida. MÉTODOS: Se realizó un estudio observacional de corte transversal. Se evaluaron a 67 lactantes (21 PEG y 46 AEG) en el 3er mes de vida. Síndromes genéticos, malformaciones congénitas, infecciones congénitas y aquellos que necesitaron de unidad de terapia intensiva neonatal fueron excluidos. Las Escalas Bayley II y de Desarrollo Infantil fueron utilizadas, con énfasis en los ítems que evalúan las habilidades motoras finas. RESULTADOS: No se observaron diferencias entre los grupos en la escala motora (p=0,21) y mental (p=0,45) en el 3er mes de vida. En el ítem "alcanza aro suspendido" hubo diferencia significativa (p=0,02; prueba Exacta de Fisher), demostrando mayor frecuencia de ejecución para el grupo PEG en el 3er mes de vida. CONCLUSIONES: Se supone que la diferencia encontrada en el ítem "alcanza el aro suspendido" pueda ser atribuida a la gran ocurrencia de movimientos de los brazos observada en el grupo PEG y no a una condición mejor de desarrollo en este grupo.

Escala de tolerancia parental hacia los comportamientos infantiles, elaboración y validación: building and validation / Parental tolerance scale towards infant behavior

Se ha postulado la existencia de una tolerancia diferencial de los padres hacia el comportamiento infantil. El constructo tolerancia parental se considera una variable compuesta por aspectos cognitivo-sociales como atribuciones, estilos parentales y emociones. El objetivo del estudio fue evaluar el sustento empírico del constructo y elaborar una escala, estableciendo su validez y confiabilidad. Las dimensiones incluidas fueron: intención, atribución disposicional, atribución de responsabilidad, afecto-enojo, afectoansiedad, expectativa de resistencia, fuerza en estilo parental, verbosidad, permisividad, reactividad excesiva. A partir del análisis factorial se obtuvieron tres factores: afectivo conductual reactivo, puesta de límites atributiva y atributivo, que explicaron el 40% de la varianza. La confiabilidad se evaluó a través de la consistencia interna (α = .74). Se concluyó que la evidencia empírica ofrece sustento empírico al constructo propuesto.

It was hypothesized that there is differential parenting tolerance towards children behavior. We defined the parental tolerance construct as a complex variable that includes some socio-cognitive variables as attributions, emotions and parenting styles. The purpose of this research was to evaluate the empirical basis for the parental tolerance towards children behavior construct as well as to develop and validate a scale. The dimensions included in the scale were intent, dispositional attribution, attribution of responsibility, anger, anxiety, expectation of resistance, forcefulness, verbosity, laxness and over reactivity. Factor analysis showed that three of the factors explained 40% of the variance. Factors were called affective behavioral reactive, non-permissive attributive and attributive. Reliability was assessed using the Cronbach alpha coefficient (alpha.74). These results provide a strong empirical support for the hypothesized construct.

Comportamentos maternos e infantis durante alimentação: estudo mediante observação / Maternal and child behavior while feeding: an observation study / Comportamientos maternos e infantiles durante alimentación: estudio mediante observación

Há estudos internacionais indicando que comportamentos maternos e interações mãe/filho durante a alimentação podem ter papel importante na determinação do estado nutricional da criança e de seu consumo de alimentos. O objetivo deste estudo foi iniciar em nosso meio o estudo desta temática descrevendo comportamentos maternos e infantis durante uma refeição (almoço), abordando díades em situação de pobreza. Trata-se de estudo transversal-descritivo, com dados obtidos mediante observação de 16 duplas mãe/filho (crianças entre 12 e 24 meses de idade) selecionadas em unidades básicas de saúde, compondo amostra intencional. Foi construído um inventário contendo 60 itens referentes a comportamentos ou sequências interativas, para guiar as observações realizadas em domicílio por duas observadoras treinadas para isso. Foram observados nas mães comportamentos característicos de três estilos alimentares: 1) nenhuma consulta à criança sobre o que desejava comer, típico do estilo autoritário; 2) alternância da alimentação ativa e por conta própria, de acordo com iniciativa da criança, característica do estilo responsivo; e 3) insistência monótona ou desistência de várias mães diante da recusa da criança a comer, comportamentos típicos do estilo passivo. Como resultado, foram detectados comportamentos maternos potencialmente adversos ao estado nutricional infantil, justificando estudos populacionais para verificar sua possível associação com desnutrição ou baixo apetite.

The international literature has indicated that maternal behaviors and mother/child interactions during feeding may play an important role in determining nutritional status and food consumption by children. This study aimed at initiating such topic in our milieu by describing maternal and child behaviors during a meal (lunch) as shown by mother/child dyads in poverty conditions. It is a cross-sectional descriptive study. Its data were obtained by observing 16 mother/child dyads (children aged 12 to 24 months) who were selected from basic health care units and formed an intentional sample. An inventory containing 60 items (behavior or interactive sequences) was designed to guide the observations performed at the participants’ homes by two trained observers. Behaviors characteristic of three feeding styles were observed in the mothers: not asking the children about what they wanted to eat, which is typical of the authoritarian style; alternation of active feeding and the children’s eating by themselves, according to their own initiative, which is typical of the responsive style, and, in face of the child’s refusing to eat, various mothers adopted monotonous insistence or stopped feeding, which is typical of the passive style. It was concluded that maternal behaviors which are potentially adverse to the child’s nutritional status were detected, thus justifying population studies with the purpose to evaluate their possible association with malnutrition or low appetite.

Hay estudios internacionales indicando que comportamientos maternos e interacciones madre/hijo durante la alimentación pueden tener un papel importante en la determinación del estado nutricional y consumo de alimentos por el niño. El objetivo de este estudio fue iniciar en nuestro medio el estudio de esta temática describiendo comportamientos maternos e infantiles durante una comida (almuerzo), enfocando díadas en situación de pobreza. Se trata de un estudio transversal descriptivo, con datos obtenidos mediante observación de 16 parejas madre/hijo (niño entre 12 y 24 meses de edad) seleccionados en unidades básicas de salud, que compusieron una muestra intencional. Se construyó un inventario con 60 ítems - comportamientos o secuencias interactivas - para guiar las observaciones, realizadas en domicilio por dos observadoras entrenadas. Se observaron en las madres comportamientos característicos de tres estilos alimenticios: ninguna consulta al niño sobre lo que deseaba comer, típico del estilo autoritario; alternancia de la alimentación activa y por cuenta propia, de acuerdo con la iniciativa del niño, característica del estilo responsivo; delante de la negativa a comer, varias madres adoptaron la insistencia monótona o se dieron por vencidas, típico del estilo pasivo. Se concluye que comportamientos maternos potencialmente adversos al estado nutricional infantil fueron detectados, justificando estudios de población para averiguar su posible asociación con desnutrición o bajo apetito.

Características clínicas de niños y adolescentes menores de 18 años hospitalizados en una clínica psiquiátrica universitaria / Clinical characteristics of children and adolescent hospitalized in a University Psychiatric Clinic

Blackground: Five percent of children and adolescents consults in mental health services in one year. Approximately one every ten children has a mental health problem. Aim To assess clinical and demographic factors of children and adolescents hospitalized by psychiatric cause in a university psychiatric clinic. Patients and Methods: Review of medical records of 167 subjects aged 9 to 17 years, 97 women, admitted to a Psychiatric Service in the period 2001-2004. The International Classification of Primary Care (ICPC) manual of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) was used to classify admission complaints and symptoms and DSMIV to classify psychiatric disorders. Results: Mean hospital stay was 11+8 days. The main admission causes were suicidal attempts and psychomotor agitation/impulsive behavior in 54 percent and 26 percent of cases, respectively. The main psychiatric diagnoses were depressive disorder, suicide attempt and bipolar disorder. In 69 percent of patients, the personality diagnosis was deferred. Only 25 percent of families were considered functional. Conclusions: Affective disorders and suicidal behavior are the main psychiatric diagnoses at discharge in children and adolescents admitted to a psychiatric impatient service.

Comportamento de lactentes nascidos a termo pequenos para a idade gestacional no primeiro ano de vida / Behavior of full term small-for-gestational-age infants in the first year of life

O objetivo deste estudo foi comparar o comportamento de lactentes nascidos a termo, pequenos para a idade gestacional (PIG) e lactentes nascidos com peso adequado para a idade gestacional (AIG), no primeiro ano de vida. Foram selecionados 125 neonatos na maternidade do Centro de Atenção Integral à Saúde da Mulher (CAISM/UNICAMP), obedecendo aos critérios de inclusão: pais ou responsáveis legais assinaram o Termo de Consentimento Livre e Esclarecido; neonatos que não necessitaram de cuidados especiais; com idade gestacional entre 37 e 41 semanas; com avaliação no 1º, 2º,3º,6º,9º,12º meses. A casuística foi composta por 95 lactentes que compareceram para pelo menos uma avaliação programada no 1º ano de vida, foi dividida em dois grupos de acordo com a adequação peso/idade gestacional; grupo PIG, constituído por 33 lactentes com peso ao nascer abaixo do percentil 10 e grupo AIG por 62 lactentes com peso entre o percentil 10 e 90 da curva de crescimento fetal de Battaglia e Lubchenco (1967). Para a avaliação do neurodesenvolvimento foram utilizadas as Escalas Bayley de Desenvolvimento Infantil II (BISID-II). Para a avaliação do comportamento do lactente, elegeu-se as Escalas de Classificação do Comportamento (ECC), das BSID-II. O estudo seccional avaliou no 1º mês: 63 lactentes (18PIG/45AIG). No 2º mês: 68 lactentes (25PIG/43AIG)...

The objective of this study was to compare the behavior of full-term small-for-gestational age (SGA) with full-term appropriate-for gestational age (AGA) infants in the first year of life. A hundred twenty five full-term neonates were selected at Neonatology Service in the Center of Integral Attention to Woman?s Health (CAISM) of the State University of Campinas (UNICAMP), São Paulo, Brazil observing the inclusion criteria as follow: parents or legal guardians who signed the Informed Consent; neonates who did not need special care; gestational age between 37 and 41 weeks. They were assessed in the 1st , 2nd ,3rd ,6th ,9th and 12th months of life. Ninety five infants who came at least to one assessment during the first year of life were the sample. This sample was divided into two groups, according to weight and gestational age. In the SGA group there were 33 infants with birth weight less than percentile 10th and, in the AGA group, there were 62 infants whose birth weight varies between the 10th and 90th percentile on fetal growing Battaglia and Lubchenco method (1967). The Bayley Scales of Infant Development-II (BSID-II) (BAYLEY, 1993) were used with emphasis on the Behavior Rating Scale (BRS). The cross-sectional study evaluated in the 1st month, 63 infants.

The Effect of Infant Massage on Weight Gain, Physiological and Behavioral Responses in Premature Infants / 간호학회지

PURPOSE: The purpose of this study was to evaluate the premature infants' responses to infant massage (tactile and kinesthetic stimulation). These responses measured by weight, physiological (vagal tone, heart rate, oxygen saturation) and behavioral responses (behavioral states, motor activities, and behavioral distress). METHODS: This study was conducted using an equivalent control pretest-posttest design. The sample was divided into two groups of 13 infants with gestational age less than 36 weeks at birth, birth weight less than 2000g, and no congenital anomalies. The experimental group received the massage intervention twice daily for 10 days. The data were collected for 10 minutes prior to and 10 minutes after the massage. RESULTS: The vagal tone was significantly higher after massage than before massage in the experimental group, while no change in the control group. The experimental group had significantly higher scores for awake state and motor activity than the control group. Significantly greater awake state, more fidgeting or crying, and increased motor activity were reported after massage than before massage. CONCLUSIONS: The results of this study showed that massage therapy might enhance optimal physiological responses and behavioral organization of premature infants. Nursing staff in the NICU can use massage to promote the infant's capability to respond positively to his environment and to provide developmental support for healthy premature infants.

Effects of Maternal Education using Brazelton Neonatal Behavioral Assessment Scale on the Mother-Infant Interaction and Infant Behavior / 아동간호학회지

This study was designed to investigate effects of maternal education using Brazelton Neonatal Behavioral Assessment Scale(the following will be marked as NBAS) on the mother-infant interaction and infant behavior. The subjects of this study consisted of 48 pairs of normal mother and infant, 24 pairs for intervention group and 24 pairs for control group. The subjects were recruited from two general hospitals, and an OBGY clinic located in J city. The data were collected from July 30, 2001 to October 6, 2001. Prior to investigation and data collection, following operational hypotheses were set up in order to compare the investigative data against these operational hypotheses(H). H1: Intervention group will higher mother-infant interaction score than control group. H2: Intervention group infants will higher overall performance in infant behavior test score than control group infants. The results of this study were summarized as follows: 1. The mother-infant interaction score was 59.79 points in intervention group and 53.91 points in control group. The mother-infant interaction score of intervention group showed significant difference than control group. Therefore, hypothesis 1 was supported. 2. The infant behavior score of intervention group was significantly higher than control group, but partially. Therefore, hypothesis 2 was partially supported. 1) The social interaction(orientation) score was 46.58 points in intervention group and 43.50 points in control group. The orientation score of intervention group showed significant difference than control group. 2) The state regulation score was 26.79 points in intervention group and 25.33 points in control group. The state regulation score of intervention group showed significant difference than control group. In conclusion, present work demonstrated that maternal education using NBAS is an effective intervention method for promotion of mother-infant interaction and of infant behavior development. Author believes that many inexperience young mother may find NBAS-based maternal education beneficial for their nursing babies, therefore NBAS-based intervention is recommended to be adopted routinely as an integral part of neonatal nursing strategies.

Behavioral Item List for Korean Infants by Naturalistic Observation / 아동간호학회지

PURPOSE: This study was conducted to identify behavioral items for Korean infants under 24months by naturalistic observation. These items will be the basis for developmental scale for Korean infants. METHOD: Data were collected by observing and interviewing fifty one infants and their mothers during the period from November 15 to December 14, 2003. Raw data in descriptive form were obtained by unstructured naturalistic observation, and were reformed to behavioral items through discussion with professors in pediatric nursing and experienced nurses in child care department. Also, behavioral items were classified into five developmental areas. RESULT: Total number of behavioral items was two hundreds and thirty eight. 52 items for motor development, 66 items for personal-social, 40 items for hearing and speech, 41 items for eye-hand coordination, and 39 items for performance. CONCLUSION: This is meaningful that fundamental items for Korean developmental scale for infants were identified by observing behaviors of Korean infants. On the basis of these items, average age will be calculated for passing each item by testing Korean infants. We hope to develop Korean infant developmental scale as a final outcome in the future research.