Pacifier Habit: Study of Family Dynamics from the Perspective of General Systems Theory

ABSTRACT: This study aimed to know perception of the marital subsystem (parents) and to understand the dynamics of the family system in offer of pacifiers. Ten couples, parents of children between 4 and 7 years old, were interviewed by means of a semi-structured script of questions about the offer of pacifiers for their children. Answers by qualitative method of content analysis, using predefined categories of the General Systems Theory (homeostasis, circularity, globality, non- summativity, morphogenesis and equifinality). Pacifier offer reestablished the Homeotasis related to adaptation of mother in postpartum period; in introduction of artificial nipples due to allergy to breast milk and to avoid thumb sucking. Circularity occurred in paternal support to stimulate breastfeeding and in offer of pacifier to reduce the dependence of baby regarding the mother. Globality occurred when offer of pacifier softened mastitis and colic of baby. Non-somivity was evidenced in the mother's attitude in controlling behavior of children with offer of pacifier. Morphogenesis predominated in influence of extern al systems (health, school, kinship, marketing and social media) on family decision to offer pacifiers. Offer of pacifiers interfe red in Equifinality, favoring the organization of family system in face of complications in breastfeeding. Offer of pacifier sought to meet emergency needs of baby, although there was a perception of consequences for child's health in long term. General Theory of Systems allowed verifying the dynamics of family system, which can be applied by health professionals in order to understand the factors involved in offer of pacifiers.

RESUMEN: Este estudio tuvo como objetivo conocer la percepción del subsistema conyugal (padres) y comprender la dinámica del sistema familiar en la oferta de chupetes. Se entrevistó a diez parejas, padres de niños entre 4 y 7 años, mediante un guión semiestructurado de preguntas sobre la oferta de chupetes para sus hijos. Respuestas por método cualitativo de análisis de contenido, utilizando categorías predefinidas de la Teoría General de Sistemas (homeostasis, circularidad, globalidad, no sumatividad, morfogénesis y equifinalidad). La oferta de chupete restableció la Homeotasis relacionada con la adaptación de la madre en el puerperio; en la introducción de pezones artificiales por alergia a la leche materna y para evitar chuparse el dedo. Ocurrió circularidad en el apoyo paterno para estimular el amamantamiento y en la oferta del chupete para reducir la dependencia del bebé con respecto a la madre. La globalidad ocurrió cuando la oferta del chupete suavizó la mastitis y el cólico del bebé. La no somividad se evidenció en la actitud de la madre en el control de la conducta de los niños con oferta de chupete. Predominó la morfogénesis en la influencia de los sistemas externos (salud, escuela, parentesco, marketing y redes sociales) en la decisión familiar de ofrecer chupetes. La oferta de chupetes interfirió en la Equifinalidad, favoreciendo la organización del sistema familiar frente a las complicaciones en la lactancia. La oferta del chupete buscó atender las necesidades de emergencia del bebé, aunque hubo una percepción de consecuencias para la salud del niño a largo plazo. La Teoría General de Sistemas permitió verificar la dinámica del sistema familiar, que puede ser aplicada por los profesionales de la salud para comprender los factores involucrados en la oferta de chupetes.

Chupete: más que un calmante / Pacifier: more than a sedative

El chupete es un dispositivo utilizado para calmar a los lactantes y niños pequeños; sin embargo, se lo asocia a efectos nocivos. Muchas veces en la consulta los cuidadores solicitan la opinión de los profesionales de la salud sobre su uso; por este motivo, decidimos realizar una búsqueda bibliográfica de la mejor evidencia disponible. En base a la información recabada y analizada, concluimos que la introducción precoz del chupete (antes de las dos semanas de vida) no afectaría el amamantamiento hasta los seis meses, y que en niños con lactancia materna bien establecida y madres motivadas para amamantar, no influye en el destete precoz. Además existe evidencia débil a favor del uso del chupete para reducir el riesgo del síndrome de muerte súbita del lactante, mientras que su uso durante la dentición primaria se asocia al desarrollo de mordida cruzada posterior. (AU)

The pacifier is a device used to soo the infants and young children; however, it is associated with harmful effects. Many times during consultation, caregivers ask for the opinion of health professionals about its use; for this reason, we decided to perform a literature search of the best available evidence. Based on the collected and analyzed information, we concluded that the early introduction of the pacifier (before two weeks of life) would not affect breastfeeding until six months of age, and that in children with well-established breastfeeding and mothers motivated to breastfeed, it does not influence early weaning. Furthermore, there is weak evidence in favor of pacifier use to reduce the risk of sudden infant death syndrome, while its use during primary dentition is associated with the development of posterior crossbite. (AU)

Fatores que impedem o aleitamento materno estendido em Unidades Básicas de Saúde de Guarulhos / Factors that prevent prolonged breastfeeding in Basic Health Units in Guarulhos

A amamentação prolongada promove diversos benefícios à saúde da criança, bem como para mãe, família e sociedade. Diante disso e da escassez de estudos sobre os aspectos envolvidos na prática do aleitamento materno após o sexto de mês de vida, o presente estudo teve como objetivo conhecer os fatores que dificultam a manutenção do aleitamento materno estendido (a partir do sexto mês até dois anos ou mais). Tratou-se de um estudo transversal, realizado em quatro unidades básicas de saúde, sorteadas, localizadas no município de Guarulhos. A amostra foi composta por mães usuárias e funcionárias das unidades básicas de saúde em questão com filhos de seis a vinte e quatro meses de idade. Para a coleta de dados foram utilizados dois questionários informativos com as variáveis do estudo. As análises de regressão simples e múltipla foram usadas para investigar a associações entre as variáveis. A utilização de mamadeira e de chupeta foram fatores importantes para a interrupção do aleitamento materno estendido. No entanto, na análise ajustada, tem-se que a idade materna predispõe a interrupção da amamentação estendida. De acordo com o modelo múltiplo de regressão logística, a utilização de chupeta aumenta em quase 20 vezes a chance de não manutenção do aleitamento materno estendido e crianças que utilizam mamadeira têm esta chance aumentada em seis vezes. Conclui-se que o avançar da idade da criança, a mamadeira e a chupeta foram determinantes para a não manutenção do aleitamento materno estendido. O retorno ao trabalho e o armazenamento do leite materno foram apontados como as principais dificuldades para manutenção da amamentação.

Prolonged breastfeeding promotes several health benefits for the child, as well as for the mother, family, and society. Given this and the scarcity of studies on the aspects involved in the practice of breastfeeding after the sixth month of life, the present study aimed to discover the factors that make it difficult to maintain breastfeeding (from six monthx to two years or more). This was a cross-sectional study, carried out in four randomly selected basic health units located in the city of Guarulhos. The sample consisted of mothers and employees of the basic health units in question, with children aged between six and twenty-four months old. For data collection, two informative questionnaires with the study variables were used. Simple and multiple regression analyses were used to investigate associations between variables. The use of a bottle and a pacifier were important factors for the interruption of prolonged breastfeeding. However, in the adjusted analysis, maternal age predisposes them to interrupt of prolonged breastfeeding. According to the multiple logistic regression model, the use of a pacifier increases the chance of not maintaining prolonged breastfeeding by almost 20-fold, and children who use a bottle have this chance increased by six-fold. It is concluded that the child aging, bottle use, and pacifier use were decisive factors for not maintaining prolonged breastfeeding. Returning to work and storing breast milk were identified as the main difficulties in maintaining breastfeeding.

Avaliação do comportamento entre mães surdas e ouvintes na oferta e tempo de uso de chupeta entre seus filhos / Behavior among deaf and normal hearing mothers in their offer and time of pacifier use among their children

A limitação da comunicação com os profissionais de saúde pode levar ao aumento da ansiedade e a instalação de hábitos prejudiciais à saúde materno-infantil entre mães surdas e seus filhos. A proposta deste estudo transversal foi comparar hábitos de sucção nutritiva e não nutritiva, ansiedade das mães e fatores socioeconômicos entre filhos de mães surdas e ouvintes. Participaram 116 pares de mães com seus filhos na faixa etária de 2-5 anos. A amostra foi composta por dois grupos: o grupo 1 (G1) de mães surdas (n=29) contatadas em um centro de referência assistencial a surdos e o grupo 2 (G2) formado por mães ouvintes (n=87 mães) selecionadas em duas escolas públicas em Belo Horizonte. Após o primeiro contato, foram agendadas visitas domiciliares para coleta de dados. As mães foram entrevistadas sobre os aspectos sociodemográficos e histórico de hábito de sucção nutritiva e não nutritiva dos filhos. Junto com a entrevista as mães completaram a versão brasileira do autoaplicável Inventário ansiedade de Beck (IAB) para avaliação da intensidade dos sintomas de ansiedade das mães na versão para surdos e na versão para ouvintes. Para mães surdas, a entrevista foi realizada utilizando a Língua Brasileira de Sinais (LIBRAS). Os testes estatísticos Qui-quadrado da razão de verossimilhança, Mann Whitney e análise de caminhos, foram utilizados para análise estatística. Os resultados foram apresentados por meio de dois artigos científicos. Artigo 1: O maior tempo de uso de chupeta está associado ao uso de mamadeira (p = 0,004), à filhos de mães ouvintes (p = 0,005) e à mães que tiveram licença maternidade (p = 0,004). A mamadeira esteve associada à ausência de aleitamento materno exclusivo (p = 0,000), que, por sua vez, esteve associado ao parto prematuro (p = 0,025). Mães surda são mais ansiosas (p = 0,002). Artigo 2: Filhos de mães surdas que usaram chupeta apresentaram maior prevalência de nascimentos prematuros (p = 0,003) e maior escore de ansiedade das mães (p=0,003) quando comparado ao grupo de mães ouvintes. O uso de mamadeira foi associado ao uso de chupeta (p< 0.001), e a longa duração do aleitamento materno esteve associada ao não uso de chupeta, independente se a mãe é surda ou ouvinte (p< 0.001). Concluiu-se que existiram diferenças entre o comportamento dos grupos estudados, sendo que o tempo de uso da chupeta foi associado ao uso de mamadeira, licença de maternidade e mães ouvintes. Mães surdas de filhos prematuros ofertaram mais chupeta aos filhos e apresentaram maior escore de ansiedade quando comparadas ao grupo de mães ouvintes. Mães que ofertaram mamadeira também utilizaram chupeta nos filhos e o maior tempo de aleitamento esteve associado as crianças que não usaram chupeta.

Limiting communication with health professionals can lead to increased anxiety and the installation of harmful habits to maternal and child health among deaf mothers and their children. The purpose of this comparative cross - sectional study was to compare children of deaf and normal-hearing mothers related to: nutritive and non-nutritive sucking habits, socioeconomic indicators and mothers anxiety. One hundred sixteen mothers and their children aged 2-5 years took part in the study. The sample was comprised of two groups: group 1 (G1) of deaf mothers (n = 29) contacted through a deaf center of care and group 2 (G2) of hearing mothers (n = 87 mothers) selected from two public preschool from Belo Horizonte. After the first contact, home visits were scheduled to collect data. The mothers were interviewed about sociodemographic indicators, breastfeeding habits and history of sucking habits of their children. Together with the interview, the mothers completed the Brazilian version of the self-applied Beck Anxiety Inventory (IAB) to assess the intensity of the mothers' anxiety symptoms in the deaf version and in the listener version. For deaf mothers, the interview was conducted using the Brazilian Sign Language (LIBRAS). Statistical tests Chi-square, Chi-square of likelihood ratio, Mann Whitney and path analysis were used for statistical analysis. The results were presented through two scientific articles. Article 1: The greater time of use of pacifier associated with bottle-feeding (p= 0.004), with children from hearing mothers (p= 0.005) and with mothers that had maternity leave (p= 0.004). Bottle feeding was associated with the absence of exclusive breastfeeding (p= 0.000), which in its turn, was associated with premature birth (p= 0.025). Deaf mothers were also more anxious (p= 0.002). Article 2: Children of deaf mothers who used a pacifier had a higher prevalence of premature births (p = 0.003) and higher level of anxiety when compared to the group of hearing mothers (p = 0.003). The use of a bottle feeding is associated with the use of a pacifier and the longer duration of breastfeeding is associated with not use of a pacifier, regardless of whether the mother is deaf or hearing (p> 0.001). It was concluded that pacifier use time was direct affected by bottlefeeding, maternity leave and hearing mothers. Deaf mothers of premature children offered more pacifiers to their children and had a higher anxiety score when compared to the group of normal-hearing mothers. Mothers who offered a bottle feeding also used a pacifier in their children and longer duration of breastfeeding was associated with children who did not use a pacifier.

Maloclusiones dentarias y su relación con los hábitos bucales lesivos / Dental malocclusion and its relationship to harmful oral habits

RESUMEN Introducción: La ruptura del equilibrio de las fuerzas extrabucales e intrabucales debido a una función anómala, desencadena maloclusión. Estas funciones musculares anómalas se conocen como hábitos bucales lesivos. Objetivo: Actualizar conocimientos y analizar los factores relacionados con las maloclusiones dentarias como los hábitos bucales lesivos en niños, en función de la frecuencia y duración de la succión nutritiva y no nutritiva, respiración por la boca y el empuje lingual atípico. Métodos: se realizó una revisión bibliográfica en cuatro bases de datos digitales Pubmed, Lilacs, Ibecs y Cumed correspondiente a los últimos 5 años. Se usó tesauro para el idioma inglés malocclusion, habits, finger sucking, pacifiers, bottle feeding, tongue habit, mouth breathing y en español maloclusión, hábitos, succión del dedo, chupete, biberones, hábitos linguales, respiración por la boca. La búsqueda reveló 65 artículos, de estos solo 19 cumplieron los criterios de inclusión. Análisis e integración de la información: El 89,5 por ciento de los artículos pertenecen a estudios de hábitos de succión no nutritivos solo o en conjunto con otros hábitos; y el 10,5 por ciento realizan investigaciones en niños respiradores bucales. Teniendo en cuenta la duración y frecuencia de los hábitos solo el 26,31 por ciento de las pesquisas seleccionadas tomaron en cuenta estas variables. En hábitos de succión nutritivos presentaron resalte horizontal aumentado, mordida cruzada posterior y escalón distal. Existe una asociación entre períodos cortos de amamantamiento y prevalencia de hábitos de succión no nutritivos; presentan además de maloclusiones anteriormente citadas, mordida abierta anterior. En respiración por la boca citaron clase II, mandíbula corta y retruida y disminución del tercio inferior de la cara. Conclusiones: Numerosas investigaciones se han realizado para asociar la duración de los hábitos de succión nutritivos y no nutritivos con maloclusiones, sin considerar la frecuencia de estos, además existe una reducida información científica en las bases electrónicas exploradas en lo que refiere a estudios de respiración por la boca y empuje lingual atípico en los niños(AU)

ABSTRACT Introduction: Malocclusion is triggered by rupture of the balance between extraoral and intraoral forces as a result of an anomalous function. Such anomalous muscular functions are known as harmful oral habits. Objective: Update knowledge and analyze factors related to dental malocclusions, such as harmful oral habits in children, in terms of the frequency and duration of nutritive and non-nutritive sucking, mouth breathing and atypical tongue thrust. Methods: A bibliographic review was conducted of papers published in the last five years in the digital databases Pubmed, Lilacs, Ibecs and Cumed. The search terms used were malocclusion, habits, finger sucking, pacifiers, bottle feeding, tongue habit and mouth breathing in English, and maloclusión, hábitos, succión del dedo, chupete, biberones, hábitos linguales and respiración por la boca in Spanish. 65 papers were obtained, of which only 39 met the inclusion criteria. Data analysis and integration: 89.5 percent of the papers corresponded to studies about non-nutritive sucking habits alone or in combination with other habits, whereas 10.5 percent dealt with studies about mouth breathing children. Only 26.31 percent of the studies selected took into account the variables duration and frequency of the habits. Nutritive sucking habits were found to be associated with overjet, posterior crossbite and distal step. A relationship was also found between a short breastfeeding period and the prevalence of non-nutritive sucking habits, with the presence of anterior open bite alongside the aforementioned malocclusions. Mouth breathing was related to class II, small retrognathic jaw and a decreased lower third of the face. Conclusions: Numerous studies have been conducted to determine the relationship between malocclusions and the duration of nutritive and non-nutritive sucking habits, without considering the frequency of such habits. On the other hand, the electronic databases consulted contain few studies about mouth breathing and atypical tongue thrust in children(AU)

Involvement of maternal grandmother and teenage mother in intervention to reduce pacifier use: a randomized clinical trial / Participação da avó materna e mãe adolescente na intervenção para redução do uso de chupeta: um ensaio clínico randomizado

Abstract Objective: To assess the impact of an intervention for teenage mothers with the involvement of maternal grandmothers on the prevalence of pacifier use in the first six months of life. Methods: This randomized clinical trial involved 323 teenage mothers, allocated to four groups: intervention with teenagers only, intervention with teenagers and their mothers, and respective controls. Six breastfeeding counseling sessions, including the recommendation to avoid the use of a pacifier, were delivered at the maternity ward and subsequently at the teenagers' homes, at seven, 15, 30, 60, and 120 days postpartum. Data on infant feeding and pacifier use were collected monthly by interviewers blinded to group allocation. The impact of the intervention was measured by comparing survival curves for pacifier use in the first six months of life and mean time to pacifier introduction. Results: The intervention had a significant impact on reducing pacifier use only in the group in which grandmothers were involved. In this group, the intervention delayed by 64 days the introduction of a pacifier (21-85 days), compared to 25 days in the group without the participation of grandmothers (65-90 days). Conclusions: The intervention reduced pacifier use in the first six months of life and delayed its introduction until beyond the first month when grandmothers were involved. The intervention did not have a significant impact when only teenage mothers were involved.

Resumo Objetivo: Avaliar o impacto de uma intervenção para mães adolescentes com a participação de avós maternas na prevalência de uso de chupeta nos primeiros seis meses de vida. Métodos: Este ensaio clínico randomizado envolveu 323 mães adolescentes, alocadas para quatro grupos: intervenção com somente adolescentes, intervenção com adolescentes e suas mães e respectivos controles. Seis sessões de aconselhamento para amamentação, incluindo a recomendação de evitar o uso de chupeta, foram realizadas na maternidade e posteriormente nas casas das adolescentes ao 7°, 15°, 30°, 60° e 120° dias. Os dados sobre alimentação infantil e uso de chupeta foram coletados mensalmente por entrevistadores cegos a respeito da alocação dos grupos. O impacto da intervenção foi medido comparando as curvas de sobrevida para uso de chupeta nos primeiros 6 meses de vida e o tempo médio de introdução de chupetas. Resultados: A intervenção apresentou um impacto significativo sobre a redução do uso de chupeta somente no grupo em que as mães estiveram envolvidas. Nesse grupo, a intervenção mostrou atraso de 64 dias na introdução de chupeta (21 a 85 dias), em comparação a 25 dias no grupo sem a participação das avós (65 a 90 dias). Conclusões: A intervenção reduziu o uso de chupeta nos primeiros 6 meses de vida e atrasou sua introdução além do primeiro mês com a participação das avós. A intervenção não teve impacto significativo somente com o envolvimento das mães adolescentes.

Uso de chupeta em pré-escolares do sul do Brasil: prevalência e fatores associados / Pacifier use in preschoolers from southern Brazil: prevalence and associated factors

Objetivo: investigar a prevalência e os fatores associados ao uso de chupeta em pré-escolares. Sujeitos e método: estudo transversal foi realizado com 1.316 crianças de 0 até 5 anos de idade no município de Canoas, no Rio Grande do Sul. O instrumento de pesquisa foi um questionário semiestruturado respondido pelos responsáveis sobre características sociodemográficas (sexo, cor da pele, idade da criança e materna, escolaridade materna, estrutura e renda familiar) e comportamentais (uso da mamadeira e aleitamento materno). O desfecho foi presença/ausência de uso de chupeta. A análise estatística compreendeu regressão de Poisson com variância robusta bruta e ajustada. Resultados: a prevalência de uso de chupeta em algum momento da vida foi de 68,1%. A análise multivariável ajustada mostrou que crianças que usaram mamadeira tiveram três vezes maior prevalência do desfecho (RP: 3,21; IC95% 2,25-4,59; p<0,001) se comparadas àquelas que nunca usaram mamadeira. Além disso, a análise adicional encontrou que crianças mais novas ainda usam a chupeta quando comparadas às mais velhas. Conclusão: conclui-se que a prevalência do uso de chupeta é alta e está associada com hábitos de nutrição. Assim, entender a associação de aspectos biopsicossociais e sua rede de causalidade torna-se essencial para o estabelecimento de estratégias de promoção de saúde na primeira infância. (AU)

Objective: to investigate the prevalence and the factors associated with pacifier use by preschoolers. Subjects and method: cross-sectional study performed with 1316 children from zero to five years of age, in the city of Canoas, RS, Brazil. The research instrument was a semi- -structured questionnaire answered by the responsible persons on sociodemographic (sex, skin color, child and maternal age, maternal level of education, and family structure and income) and behavioral (bottle-feeding and breastfeeding) characteristics. The outcome was the presence/absence of pacifier use. The statistical analysis included Poisson regression with crude and adjusted robust variance. Results: the prevalence of pacifier use at some point in life was 68.1%. The adjusted multivariate analysis showed that bottle-fed children presented a threefold higher prevalence of the outcome (PR: 3.21, 95%CI 2.25-4.59, p<0.001) compared to those who had never used the bottle. Moreover, an additional analysis found that younger children still use the pacifier compared to older ones. Conclusion: it is concluded that the prevalence of pacifier use is high and it is associated with nutrition habits. Thus, understanding the association of biopsychosocial aspects and their causality network becomes essential for establishing health promotion strategies in early childhood. (AU)

Preterm birth, pacifier use and breastfeeding: is there a relationship?

Abstract The immaturity of born to preterm infants may predispose to sucking difficulties. This research aimed to evaluate if pacifier use is associated with preterm birth and influenced in type of infant feeding. This comparative cross-sectional study was conducted in Belo Horizonte, Brazil and evaluated 250 children aged 3 to 5 years. As a sample, two groups were established: the normal term children group (n=125) was selected at a day-care centre and the group of preterm children (125) was identified at a public university hospital with a preterm care project from birth to seven years of age. To collect data, a pre-tested questionnaire regarding information on gestational age, infant development, infant feeding and non-nutritive sucking habits was used for both groups. Bivariate and multivariate Poisson regression was used for the statistical analysis. Pacifier use was more prevalent in the preterm group (PR=1.20, 95% CI=1.02-1.42) who used the bottle (PR=1.38, 95% CI=1.15-1.64) and were breastfed for less than six months (PR=1.19, 95% CI=1.01-1.41). The majority of breastfed infants were of normal term birth (PR=1.14, 95% CI=1.04-1.20) and had monthly family income greater than USD 450.28 (RP= 1.10, 95% CI=1.01-1.20). In this study, pacifier use was more prevalent among preterm infants and associated with less than six months of breastfeeding and used of bottle. Monthly family income was associated with a prevalence of breastfeeding.

Resumo A imaturidade no nascimento para pretermos pode os predispor a dificuldades de sucção. Esta pesquisa teve como objetivo avaliar se o uso de chupeta está associado ao nascimento prematuro e ao tipo de alimentação infantil. Este estudo transversal comparativo foi realizado em Belo Horizonte, Brasil e avaliou 250 crianças de 3 a 5 anos. A amostra foi composta por dois grupos: o grupo de crianças nascidas a termo (n = 125) que foi selecionado em uma creche e o grupo de crianças pré-termo (125) que foi contatado em um hospital universitário público vinculado a um projeto de cuidados pré-termo desde o nascimento até os sete anos de idade. Para coletar dados, um questionário pretextado sobre informações da idade gestacional, desenvolvimento infantil, alimentação infantil e hábitos de sucção não nutritiva foram utilizados para ambos os grupos. Análises bivariada e Regressão de Poisson multivariada foram utilizadas para a análise estatística. O uso de chupeta foi mais prevalente no grupo pré-termo (RP = 1,20, IC95% = 1,02-1,42), que usou a mamadeira (RP = 1,38; IC95% = 1,15-1,64) e foram amamentados ao seio por menos de seis meses (RP = 1,19, 95% IC = 1,01-1,41). A maioria das crianças amamentadas ao seio nasceram a termo (RP = 1,14, 95% IC = 1,04-1,20) e com renda familiar mensal maior que USD 450,28 (RP = 1,10, 95% IC = 1,01-1,20). Neste estudo, o uso de chupeta foi mais prevalente entre os prematuros e associado com a amamentação ao seio por menos de seis meses e uso de mamadeira. A renda familiar mensal associou-se a uma prevalência de prática da amamentação ao seio.

O uso de chupetas influencia no tempo de aleitamento materno? / Does de use of pacifiers influence breastfeeding time?

O objetivo desse estudo foi avaliar se a duração do aleitamento materno exclusivo sofre influência pelo uso da chupeta a partir do 15º dia de vida. Foi realizado um ensaio clínico randomizado, envolvendo 132 mães de recém-nascidos a termo, saudáveis, de uma maternidade pública Amiga da Criança. Elas foram randomicamente alocadas em um dos 2 grupos. O grupo A "Oferecer chupeta" era orientado a usar chupeta após o 15º dia de vida e o Grupo B ,"Não oferecer chupeta". Todas as mães foram entrevistadas 3 e 6 meses após o nascimento. Foram identificados 4 grupos : I-Continuou usando chupeta(n=51); II-Não usou chupeta(n=15); III-começou a usar chupeta(n=17); IV-Nunca usou chupeta (n=49). A taxa de aleitamento materno exclusivo (AME) foi maior no grupo que não usou a chupeta, aos 3 e aos 6 meses(p=0,003 e p=0,001) Na análise multivariada, o Risco relativo (RR) para o desmame, ajustado para o peso de nascimento e problemas na amamentação, não foi significativo aos 3 meses. Entretanto, aos 6 meses, o RR foi 1,58 (1,12-222) no grupo que usou a chupeta até os 6 meses e RR=1,81 (1,22-1,69) no grupo que iniciou o uso de chupeta. O uso da chupeta não teve influência no tempo de aleitamento materno total nem nas taxas de AME aos 3 meses. No entanto, houve um efeito negativo nas taxas de AME aos 6 meses.

Abstract: The objective of this study was to evaluate whether the duration of exclusive breastfeeding is influenced by pacifier use as of the 15th day of life. A randomized clinical trial involving 132 mothers of healthy full-term newborns from a public maternity hospital was conducted. They were randomly assigned to one of 2 groups. Group A "Offer pacifiers" was oriented to use pacifiers after the 15th day of life and Group B, "Do not offer pacifiers." All mothers were interviewed 3 and 6 months after birth. Four groups were identified: I-Continued using pacifiers (n = 51); II-Did not use a pacifier (n = 15); III-started using pacifiers (n = 17); IV-Never used a pacifier (n = 49). The exclusive breastfeeding rate (EB) was higher in the group that did not use the pacifier at 3 and 6 months (p = 0.003 and p = 0.001). In the multivariate analysis, Relative Risk (RR) for weaning, adjusted for Birth weight and problems in breastfeeding, was not significant at 3 months. However, at 6 months RR was 1.58 (1.12-222) in the group that used the pacifier until 6 months and RR = 1.81 (1.22-1.69) in the group that started the use of pacifier. The use of the pacifier had no influence on the total breastfeeding time or on the AME rates at 3 months. However, there was a negative effect on AME rates at 6 months.

Síndrome de muerte súbita del lactante / Sudden Infant Death Syndrome (SIDS)

Resumen El síndrome de muerte súbita del lactante es la principal causa de muerte infantil post neonatal en los países desarrollados. El mismo se caracteriza por una muerte repentina e inexplicable de un infante menor a un año. La compleja interacción de múltiples factores en su patogénesis se ilustra con la teoría del triple riesgo, la cual involucra un infante vulnerable en un periodo crítico de su desarrollo ante un factor de riesgo externo. Por medio de educación a los cuidadores y padres se ha documentado una disminución importante en su incidencia, aunque la misma continúa siendo muy alta.

Abstract Sudden infant death syndrome is the leading cause of post neonatal infant death in the developed countries. It is characterized for the sudden and unexplained death of an infant younger than one year old. The interaction of multiple factors in its pathogenesis is illustrated by the triple risk theory, which involves a vulnerable infant at a critical moment of its development facing an external risk factor. Through education to caregivers and parents a drop in incidence has been documented, although it is still very high.

Factors associated with pacifier use among children of working women with childcare in the workplace / Fatores associados ao uso de chupeta entre filhos de mulheres trabalhadoras com creche no local de trabalho

ABSTRACT Purpose: to identify the prevalence of pacifier use as well as the reasons for introducing a pacifier and to analyze factors associated with this practice among children of working women with childcare in the workplace. Methods: a cross-sectional study was conducted with 46 women working at a higher education institution that offered childcare in the workplace; the children were in the age range 2.6 years. Data collection was carried out using a self-report questionnaire filled at home. Reasons for introducing a pacifier were analyzed descriptively; Poisson regression was used in the multiple analysis. Results: the prevalence of pacifier use was 63%. Most women offered the pacifier after the infant's 16th day of life, in order to calm the baby. In the multiple analysis, higher maternal education was associated with pacifier use. Conclusion: a high prevalence of pacifier use was observed, as well as early pacifier introduction, among children of working women with childcare in the workplace. With regard to the factors associated with pacifier use in this population, lower maternal education acted as a protective factor against pacifier use.

RESUMO Objetivo: identificar a prevalência de uso da chupeta e os motivos para sua introdução além de analisar os fatores associados a essa prática entre filhos de mulheres com creche no local de trabalho. Métodos: estudo transversal realizado com 46 mulheres trabalhadoras de uma Instituição de Ensino Superior com creche no local de trabalho, mães de crianças com idade média de 2,6 anos. Para coleta de dados, utilizou-se questionário enviado para casa. Procedeu-se análise descritiva dos motivos da introdução da chupeta e para a análise múltipla utilizou-se regressão de Poisson. Resultados: a prevalência do uso de chupeta foi de 63%. A maioria ofereceu a chupeta após o 16º dia, com o intuito de acalmá-la. Na análise múltipla, a maior escolaridade materna associou-se ao uso de chupeta. Conclusão: constatou-se a alta prevalência de uso e introdução precoce de chupeta entre filhos de mulheres trabalhadoras com creche no local de trabalho. Com relação aos fatores associados ao uso de chupeta nesta população verificou-se a menor escolaridade das mães como fator de proteção ao uso de chupeta.

Non-nutritive sucking habits among preschool children in southern Saudi Arabia: A cross-sectional study

Prolonged non-nutritive sucking habits have negative effects on child’s orofacial structures, physical, social and psychological wellbeing. The objectives of the present study were (1) to determine the prevalence of non-nutritive sucking habit in Saudi preschool children, (2) to assess the factors influencing the habit, (3) to determine mothers’ view on causes of non-nutritive sucking and their reasons to stop the habit and (4) to report methods used by the mothers in eliminating the habit. This cross-sectional observational study was conducted in the kindergartens in Abha and Khamis Mushayt cities. The sample included parents of 328 male and female preschool children. A pre-piloted self-administered questionnaire was used for data collection and the response rate was 85.4%. The prevalence of non-nutritive sucking habit was 46.6%; of these, pacifier sucking was 30.2% and digit sucking was 16.4%. There were significant differences with pacifier habit between mother’s educational status and sex (p=0.008 and p=0.002 respectively). The odds of pacifier habit were higher in females [OR=2.14, 95% CI (1.32, 2.52)] and mothers with higher university education [OR=1.67, 95% CI (1.03, 2.72)]. There were significant differences with digit sucking habit and mothers’ educational status (p=0.022). The odds of digit sucking habit was higher in mothers with intermediate and secondary education [OR=2.25, 95% CI (1.24, 4.07)]. Some mothers (37.90%) used non-nutritive sucking as solution to calm the crying child, while others (47.05%) wanted to stop the habit as it might affect the child’s dentition. Some mothers (37%) interrupted the habit physically, while only 10% had preferred to consult the dentist.

Association between maternal breastfeeding and the development of non-nutritive sucking habits / Relação entre aleitamento materno e o desenvolvimento de hábito de sucção não nutritiva

To analyze the association of maternal breastfeeding time with the introduction of non-nutritive sucking habits in children attending the Baby Clinic at the Araçatuba College of Dentistry, Universidade Estadual Paulista Júlio de Mesquita.

Analisar a associação do tempo de aleitamento materno na instalação de hábitos de sucção não nutritiva em crianças atendidas na Bebê Clínica da Faculdade de Odontologia de Araçatuba da Universidade Estadual Paulista Júlio de Mesquita Filho.

Research on the effects of sucking lollipops and pacifier on gastrointestinal function in infants after abdominal surgery / 中国实用护理杂志

Objective To investigate the effects of early sucking a lollipop and pacifier to improve the recovery of gastrointestinal function in infant after gastrointestinal operation. Methods The infants after gastrointestinal operation were divided into four groups according to the random number table method, namely group Ⅰ, Ⅱ, Ⅲ and Ⅳ. Four groups were given different interventions in addition to routine nursing care after anesthesia awake, group Ⅰsucked a lollipop,while groupⅡsucking pacifier. Intervention time of 2 groups were 20-30 minites. GroupⅢsucked the pacifier 20-30 minites first, then sucked a lollipop 20-30 minites. Each group was given one intervention every 4 hours until infant eated. Group Ⅳ was given no interventions. Bowel sounds recovery time, first bowel movement time for the first time were compared. SPSS 17.0 software was used for statistical analysis. Results A total of 82 infants completed the clinical observation. Bowel sounds recovery time of group Ⅰ,Ⅱ,Ⅲ were (28.54±9.93), (34.10±9.43), (28.50±9.52) h, while first bowel movement time were (50.02±11.60), (57.65±15.28), (49.97±15.46) h, which were earlier than group Ⅳ whose bowel sounds recovery time and first bowel movement time were (39.55 ±11.22) h, (65.43 ±14.78) h. The bowel movement time and first bowel movement time of group Ⅲ were earlier than that of groupⅡ (P0.05). Conclusions Infants early sucking a lollipop and pacifier after gastrointestinal operation help gastrointestinal function recovery, but the lollipop is superior to the pacifier, lollipops and no interaction between pacifier.

Pacifier-sucking habit duration and frequency on occlusal and myofunctional alterations in preschool children

The objective of this study was to evaluate the association of pacifier-sucking habit with occlusal and oral myofunctional alterations in preschool children. Eighty-four 2- to 5-year-old children participated in the study. Data on duration and frequency of pacifier use were collected from parents or guardians. Occlusal and oral myofunctional characteristics were examined by a dentist and a speech therapist, respectively. Chi-square tests and Poisson regression were used to analyze the data. The occlusal characteristics that were significantly associated with a pacifier-sucking habit were anterior open bite, altered canine relation, posterior crossbite, increased overjet, and malocclusion. The oral myofunctional characteristics that were significantly associated with a pacifier-sucking habit were resting lip position, resting tongue position, shape of the hard palate, and swallowing pattern. The strongest associations were for anterior open bite (prevalence ratio [PR] = 11.33), malocclusion (PR = 2.33), altered shape of the hard palate (PR = 1.29), and altered swallowing pattern (PR = 1.27). Both duration and frequency of pacifier-sucking habit were associated with occlusal and oral myofunctional alterations. These results emphasize the need for pediatric dentists to advise parents and caregivers about the risks of prolonged pacifier use and refer children to professionals for multidisciplinary assistance to minimize these risks whenever necessary.

Tempo de aleitamento materno e os fatores de risco para o desmame precoce / Breastfeeding duration and risk factors for early weaning

BACKGROUND: The World Health Organization (WHO) suggests exclusive breastfeeding until six months of age. However, the most recent epidemiological studies in Brazil showed increased levels of early weaning. The pacifier has been mentioned among the risk factors for breastfeeding interruption. OBJECTIVE: this study aimed to verify breastfeeding duration and risk factors to early weaning among children of private kindergarten. METHODS: We held a cross sectional study with 55 children aged between 0 and 18 months, of 5 kindergartens in Porto Alegre, RS. The families answered questionnaires with data on pregnancy, birth and breastfeeding period, as well as about the mother's socio demographics characteristics. The study was approved by the Ethical Committee of Hospital Moinhos de Vento (HMV-POA). The t student test, Qui Square, Kaplan-Meier and Poisson Regression were applied. The level of significance adopted was p< 0.05. RESULTS: The prevalence of breastfeeding at 6 months was 1.8%. The average duration of breastfeeding was 180 days and the average duration of exclusive breastfeeding was 90 days. There was a positive association between weaning and pacifier use during the first days of life (RP 2.30 IC95%[1.02 a 4.91] p= 0.030). Receiving breastfeeding counseling during pregnancy was protection factor from early weaning (RP 0.60 IC95% [0.37 a 0.94] p=0.032). CONCLUSION: The prevalence of breastfeeding was beneath those proposed by WHO. The use of pacifier was determinant for early weaning, while receiving breastfeeding counseling helped to prevent early weaning

INTRODUÇÃO: A Organização Mundial da Saúde preconiza o aleitamento materno exclusivo até o sexto mês de vida. Contudo, os últimos estudos de base epidemiológica realizados no Brasil revelam altos índices de desmame precoce. Dentre os fatores de risco para a interrupção da amamentação, o uso da chupeta vem sendo muito citado. OBJETIVO: Verificar o tempo de aleitamento materno e os fatores de risco para o desmame precoce em crianças frequentadoras de escolas particulares de educação infantil. MÉTODOS: Realizado estudo transversal com 55 crianças de 0 a 18 meses matriculadas em 4 escolas de Porto Alegre, RS. Aplicados questionários para coleta de dados sobre a gestação, nascimento, aleitamento materno e características sociodemográficas da mãe. Estudo aprovado pelo comitê de ética do Hospital Moinhos de Vento, Porto Alegre. Aplicados testes t Student, Qui Quadrado Kaplan-Meier e Regressão de Poisson. Aceito nível de significância p<0,05. RESULTADOS: A prevalência de Aleitamento Materno Exclusivo (AME) no sexto mês de vida foi de 1,8%. A mediana de Aleitamento Materno foi 180 dias e a mediana de aleitamento materno exclusivo foi 90 dias. Houve associação positiva entre desmame e introdução da chupeta nos primeiros dias (RP 2,30 IC95% [1,02 a 4,91] p= 0,030). Receber orientação sobre aleitamento durante a gestação foi fator importante para prevenir o desmame precoce (RP 0,60 IC95% [0,37 a 0,94] p=0,032). CONCLUSÃO: A prevalência de AME no grupo estudado foi muito aquém do preconizado pela OMS. O uso de chupeta foi determinante para desmame precoce, enquanto a orientação adequada sobre aleitamento materno interferiu para prevenir o desmame precoce

Effect of pacifiers plus touching intervention on venipuncture pains in neonates / 现代临床护理

Objective To explore the effect of pacifiers plus touching intervention on venipuncture-induced pains in newborn babies.Methods Ninety two neonates undergoing venous puncturing were randomly divided into touching intervention group and pacifiers plus touching group.During and after the venipuncture,the neonatal pain score,heart rate and blood oxygen saturation were compared between the two groups.Results The degree of pain perception in the pacifiers plus touching group was significantly lower than that in the only touching group(P<0.001).During and afterpuncturing the heart rate of the pacifiers plus touching group was significantly lower than that in the only touching group.However,the blood oxygen saturation was significantly higher(P<0.05). Conclusion Pacifiers plus touching can effectively relieve venipuncture-induced pains in neonates.

Uso del chupete de entretención en la primera infancia y su influencia en el desarrollo posterior de sobrepeso y obesidad entre los 5 y 18 años de edad / Pacifier use in early childhood and its influence on further development of overweight and obesity between 5 and 18 years old

Para evaluar el efecto que tendría el uso del chupete de entretención durante los primeros 5 años de vida sobre el peso futuro de esos niños entre los 5 y 18 años de edad, se evaluó el estado nutricional de 400 niños de 5 a 18 años en una consulta pediátrica general privada y se les investigó mediante encuesta a la madre, sobre el uso del chupete y tiempo de su uso entre el ano y los 5 años de edad. En el grupo que no usó chupete, los varones representaron un 48% las ninas 52%; 62,3% tenían sobrepeso y 16,6% presentó obesidad. En el grupo que si usó chupete, los varones representaron el 53,8% las niñas un 46.2% y el 30,7% tenía sobrepeso y sólo 5,3% presentó obesidad. Los grupos fueron comparables en sexo y edad. No se encontraron diferencias por sexo en el uso del chupete. El porcentaje de niños eutróficos, fue significativamente mayor en el grupo que usó chupete en relación a los niños que no usaron chupete. El porcentaje de niños con sobrepeso u obesidad fue significativamente mayor en el grupo de niños que no usaron chupete en relación a los niños que usaron chupete. Tanto el análisis bivariado como el logístico multivariado, considerando el uso del chupete como variable dependiente, el estado nutricional, sexo y edad, son consistentes en que sólo la variable estado nutricional se asoció al uso del chupete.

The potential effect of the use pacifier of use during the first 5 years of life on the weight of the child between 5 and 18 years of age was assessed. The nutritional status of 400 children between 5 and 18 years of age in a private pediatric practice was investigated by questioning the mother on pacifier use between one and 5 years of age. In the group that did not use pacifier, males accounted for 48%, girls for 52%, and 62.3% were overweight and 16.6% obese. In the group using a pacifier, males accounted for 53.8%, girls 46.2% and 30.7% were overweight and only 5,3% were obese. The groups were comparable in age and sex and there were no gender differences in the use of pacifiers. The percentage of eutrophic children was significantly higher in the group who used a pacifier in relation to the one who did not. The prevalence of overweight or obesity was significantly higher in the group of children who did not use a pacifier in relation to children who used a pacifier. Both bivariate and multivariate logistic analysis, considering the use of a pacifier as a dependent variable and nutritional status, sex and age, are consistent in that only the variable nutritional status was associated with pacifier use.

Práticas alimentares no primeiro ano de vida de filhos de adolescentes / Adolescents' infant feeding practices in the first year of life

OBJETIVO: Estudar as práticas alimentares de menores de um ano, filhos de adolescentes, residentes no município de Volta Redonda (RJ). MÉTODOS: Estudo transversal com 1 014 crianças selecionadas aleatoriamente na Campanha de Multivacinação de 2006, com aplicação de questionário fechado (recordatório de 24h). Foram analisadas características das mães e de seus filhos. As prevalências de aleitamento materno, aleitamento materno exclusivo, aleitamento materno predominante, a oferta de outros leites, a alimentação no primeiro dia em casa, a alimentação complementar oportuna, a oferta de sólidos ou semi-sólidos, e o uso de chupetas e mamadeiras foram investigadas. RESULTADOS: As prevalências aleitamento materno, aleitamento materno exclusivo e aleitamento materno predominante foram 85,5 por cento, 32,0 por cento e 9,6 por cento, respectivamente, sem diferenças entre filhos de adolescentes e adultas. A oferta de outros leites, entretanto, foi significativamente maior junto aos filhos de adultas (45,3 por cento, contra 31,2 por cento observados entre adolescentes). Maiores de seis meses, filhos de adolescentes, revelaram menor prevalência de aleitamento materno que os de adultas (49,2 por cento e 66,0 por cento, respectivamente), assim como maior frequência no uso de chupetas, com diferenças significativas. A alimentação complementar foi similar entre filhos de adolescentes e adultas, com predominância da oferta de sopas ou papas. Carne e feijão foram utilizados com mais frequência em sólidos. CONCLUSÃO: Não foram observadas diferenças no aleitamento considerando a variável idade materna, adolescente ou não, antes de seis meses de vida e sim após esse período. Nos maiores de seis meses, chama também a atenção o maior no uso de chupetas, assim como a oferta e as características da alimentação complementar de filhos de adolescentes. Estudos de natureza compreensiva mostram-se necessários.

OBJECTIVE: The objective of this work was to study the feeding practices of adolescent mothers' infants under one year of age living in the city of Volta Redonda (RJ). METHODS: This cross-sectional study included 1,014 infants selected randomly at the 2006 Multiple Vaccination Campaign. The 24-hour recall was used. Characteristics of the mothers and infants were analyzed. The prevalences of breastfeeding, exclusive and predominant breastfeeding and the use of other kinds of milk, in addition to the feeding practices in the first day at home and use of complementary foods, solid or semi-solid foods and pacifiers and bottles were investigated. RESULTS: The prevalences of breastfeeding and exclusive and predominant breastfeeding were 85.5 percent, 32.0 percent and 9.6 percent, respectively, with no differences between adolescents' and adults' children. Adult mothers were significantly more likely to offer other kinds of milk than adolescent mothers (45.3 percent and 31.2 percent respectively). Infants at six or more months of age of adolescent mothers were significantly less likely to be breastfed than those of adult mothers (49.2 percent and 66.0 percent respectively) and more likely to be given pacifiers. Adult and adolescent mothers presented similar complementary feeding practices, with soups and soft foods prevailing. Meat and beans were the most common solid foods given to the infants. CONCLUSION: There are no differences in breastfeeding practices among mothers of different ages, whether adolescent or not, in the first six months of an infant's life but the practices do differ after this age. Among the six-monthold infants or older of adolescent mothers, the extensive use of pacifiers and the characteristics of the complementary foods deserve attention. Comprehensive studies are necessary.

Uso de chupeta: história e visão multidisciplinar / Pacifier habit: history and multidisciplinary view

OBJETIVOS: Resgatar a história da chupeta e fazer um levantamento multidisciplinar da literatura, buscando prós e contras, com o propósito de oferecer aos profissionais da saúde subsídios para orientarem os pais. FONTES DOS DADOS: O levantamento histórico foi realizado em livros de história, arte, literatura secular, museus, e a busca de dados, em livros e nas bases MEDLINE, LILACS, SciELO e Biblioteca Cochrane. Os limites para busca foram: pacifiers, últimos 5 anos, com resumo, texto em português, inglês ou espanhol. SÍNTESE DOS DADOS: Existem evidências de que os precursores da chupeta foram empregados desde o período neolítico para acalmar as crianças. Bolinhas de pano que continham alimentos ficaram imortalizadas em telas. Outras, feitas de materiais não perecíveis, resistiram ao tempo. A chupeta tem sido utilizada para estimular a sucção ou para coordenar esse reflexo, antecipando o início da alimentação oral de recém-nascidos. Alguns sugerem que diminui a incidência de morte súbita, mas o assunto é controverso. Ela impede o estabelecimento da mamada e induz ao desmame. Pode provocar asfixia, intoxicações ou alergias e aumenta o risco de cáries, infecções e parasitoses intestinais. Efeitos deletérios se associam à frequência, duração e intensidade do hábito, que deve ser descontinuado entre os 3 e 4 anos para não repercutir sobre a fala e a dentição. CONCLUSÕES: Foram encontrados mais efeitos deletérios do que benéficos. Recomenda-se que os profissionais da saúde ofereçam aos pais dados sobre os prós e contras da chupeta para que eles tomem uma decisão informada sobre seu uso.

OBJECTIVES: To review the history of pacifiers and to compile a multidisciplinary literature review, searching for pros and cons with the purpose of providing health professionals with arguments when parents request guidance. SOURCES: History and art books, as well as non-medical literature and museums were used in the historical survey. Multidisciplinary data were collected from MEDLINE, LILACS, SciELO, and The Cochrane Library. Search criteria were: the keyword "pacifiers" present in articles published in the last 5 years that included abstract and were written in Portuguese, English, or Spanish. SUMMARY OF THE FINDINGS: There is evidence that their precursors have been used since the Neolithic Period to calm down children. Small balls made of fabric containing food were portrayed in paintings. Other balls made of non-perishable material persisted throughout time. Pacifiers have been used to stimulate sucking or to coordinate this reflex, promoting an earlier beginning of the oral feeding of newborns. Some authors suggest that pacifiers reduce the incidence of the sudden death syndrome, but the topic is controversial. Pacifiers prevent the establishment of breastfeeding and lead to weaning. Their use may cause suffocation, poisoning, or allergies and increases the risk of caries, infections, and intestinal parasitic diseases. Harmful effects are related to frequency, duration, and intensity of the habit. It should be discontinued by the age of 3 or 4 in order not to affect speech and dentition. CONCLUSIONS: There are more harmful effects than benefits. It is advisable that health professionals inform parents of the pros and cons of pacifiers so that they can make a conscious decision regarding its use.