Uso del chupete y efectos sobre la salud- una revisión de la literatura / Use of pacifiers and effects on health: a literature review

Objetivos. Conocer los efectos beneficiosos y perjudiciales sobre la salud que produce el uso del chupete en los recién nacidos y la población lactante. Elaborar recomendaciones que permitan a las enfermeras asesorar sobre el uso del chupete. Método. Revisión integradora en las bases de datos PubMed, Biblioteca Cochrane Plus, Cochrane Library, Biblioteca Virtual en Salud, JBI COnNECT+, Trip Database; el metabuscador Google Académico, y la revista de divulgación científica Anales de Pediatría. Los artículos se seleccionaron atendiendo a los criterios establecidos. Resultados. Se obtuvieron 1897 artículos; el 2.3% (n = 44) fue incluido. De estos, el 6.8% (n = 3) trata temas relacionados con el cuidado del chupete; y el 93.2% (n = 41) restante, sobre efectos derivados de su uso. Conclusión. Se ha logrado establecer cuáles son los efectos derivados del uso del chupete; se han planteado recomendaciones para guiar la toma de decisiones; y se han detectado posibles futuras líneas de investigación

Objectives. To know which beneficial and harmful effects on health are produced to the infant population by the use of pacifiers. To develop recommendations based on the evidence that allows nurses to ad-vice on the use of pacifiers. Methodology. Integrative review of literature in PubMed, Biblioteca Cochrane Plus, Cochrane Library, Biblioteca Virtual en Salud, JBI COnNECT+, Trip Database; the meta search engine Google Scholar, and the scientific Anales de Pediatría magazine. Articles were selected according to inclusion and exclusion criteria. Results. It was obtained 1897 articles, which 2.3% (n = 44) of these were included. The 6.8% (n = 3) of included articles is related to the pacifier care; and the 93.2% (n = 41), on the effects arising from its use. Conclusions. Has been established which effects arise from the use of pacifiers. Also, recommendations have been proposed to guide making decisions. At the same time, possible future lines of research have been detected

When is the use of pacifiers justifiable in the baby-friendly hospital initiative context? A clinician's guide.

BACKGROUND: The use of pacifiers is an ancient practice, but often becomes a point of debate when parents and professionals aim to protect and promote breastfeeding as most appropriately for nurturing infants. We discuss the current literature available on pacifier use to enable critical decision-making regarding justifiable use of pacifiers, especially in the Baby-Friendly Hospital Initiative context, and we provide practical guidelines for clinicians. DISCUSSION: Suck-swallow-breathe coordination is an important skill that every newborn must acquire for feeding success. In most cases the development and maintenance of the sucking reflex is not a problem, but sometimes the skill may be compromised due to factors such as mother-infant separation or medical conditions. In such situations the use of pacifiers can be considered therapeutic and even provide medical benefits to infants, including reducing the risk of sudden infant death syndrome. The argument opposing pacifier use, however, is based on potential risks such as nipple confusion and early cessation of breastfeeding. The Ten Steps to Successful Breastfeeding as embedded in the Baby-Friendly Hospital Initiative initially prohibited the use of pacifiers in a breastfeeding friendly environment to prevent potential associated risks. This article provides a summary of the evidence on the benefits of non-nutritive sucking, risks associated with pacifier use, an identification of the implications regarded as 'justifiable' in the clinical use of pacifiers and a comprehensive discussion to support the recommendations for safe pacifier use in healthy, full-term, and ill and preterm infants. The use of pacifiers is justifiable in certain situations and will support breastfeeding rather than interfere with it. Justifiable conditions have been identified as: low-birth weight and premature infants; infants at risk for hypoglyceamia; infants in need of oral stimulation to develop, maintain and mature the sucking reflex in preterm infants; and the achievement of neurobehavioural organisation. Medical benefits associated with the use of pacifiers include providing comfort, contributing towards neurobehavioural organisation, and reducing the risk of sudden infant death syndrome. Guidelines are presented for assessing and guiding safe pacifier use, for specific design to ensure safety, and for cessation of use to ensure normal childhood development.

[Use of pacifiers and breastfeeding]. / Uso del chupete y lactancia materna.

Pacifiers are widely used in developed societies. They are used for soothing infants, reducing their stress and pain during procedures and to help them sleep. The use of pacifiers has been associated, however, with a shorter duration and exclusivity of breastfeeding, with higher rates of otitis media and dental problems, as well as a higher risk of accidents during infancy. Recent studies have also described a relationship between pacifier use and SIDS, especially when used during infant́s sleep. Other described benefits are analgesia and stimulation of non-nutritive sucking in preterm and term infants. There is, at present, wide debate and controversy on whether or not to recommend its use; thus it seems important for professionals and parents to be aware of the risks and benefits associated to its use, particularly related to breastfeeding. Due to the existing controversy of scientific findings, the Committee on Breastfeeding of the Spanish Paediatrics Society, publishes this review, trying to summarise present evidence with the objective of, after analysing scientific results and recommendations, making recommendations regarding the use of the pacifier in the breastfed infant.

Avaliação de chupetas disponíveis no mercado nacional segundo os requisitos da ABNT e ANVISA / Evaluation of the pacifers available in the nacional market following the ABNT and ANVISA requisitions

Este trabalho objetivou avaliar chupetas disponíveis no mercado nacional segundo requisitos definidos pela legislação vigente. A amostra constou de 31 tipos de 6 marcas comerciais nacionais de chupetas, sendo para cada uma adquiridas 3 exemplares de lotes diferentes. Foi analisada descritivamente a adequação ou não dos aspectos: bico, escudo, botão, pino, argola e embalagem, atendendo aos critérios de construção de chupetas definidos pela NBR 10334/2003 da ABNT e a Resolução nº 221 da ANVISA. As chupetas foram divididas em grupos (G), conforme as características do bico: G1 – universal < 6 meses; G2 – convencional < 6 meses; G3 – ortodôntica < 6 meses; G4 – universal > 6 meses; G5 – convencional > 6 meses; G6 – ortodôntica > 6 meses. Verificou-se a inadequação nos itens: A – comprimento do bico; B – embalagem segundo a NBR; C – embalagem segundo a ANVISA. O percentual de inadequação encontrado para os grupos foi: A: G2 – 20%, G6 – 11,1%; B: G2 – 40%, G3 – 33,3%, G5 – 40%, G6 – 33,3%; C: G2 – 20%, G3 – 33,3%, G4 – 33,3%, G5 – 20%, G6 – 22,2%. Para os demais itens avaliados: material e forma do bico; concavidade do escudo, quantidade e diâmetro dos furos, distância do furo ao bico e à borda externa, distância entre os furos, tamanho do escudo; projeção do botão; orifício de ventilação e projeção do pino e largura e comprimento da argola constataram- se adequação para as chupetas analisadas. Conclui-se que a maioria das chupetas se apresentou adequada para os requisitos de construção, sendo a inadequação freqüentemente registrada no item embalagem.

Avanços na norma brasileira de comercialização de alimentos para idade infantil / Advances in the Brazilian norm for commercialization of infant foods

OBJETIVO: Analisar os avanços na Norma Brasileira de Comercialização de Alimentos para Lactentes no período de 1988 a 2002, comparando seus diferentes textos entre si e com o Código Internacional de Comercialização de Substitutos do Leite Materno. MÉTODOS: Trata-se de um estudo descritivo, cujos dados foram obtidos em documentos, relatórios, portarias e resoluções do Ministério da Saúde. As versões utilizadas na comparação foram a de 1992 e a de 2002. RESULTADOS: A análise comparativa permitiu identificar importantes avanços na legislação. Em 1992, foram incluídos os leites fluídos, em pó, as chupetas e frases de advertência na propaganda e na rotulagem dos produtos. Em 2002, a regulamentação dos produtos foi publicada pela Agência Nacional de Vigilância Sanitária, fortalecendo a ação de fiscalização e incluindo a regulamentação dos alimentos para crianças de primeira infância, fórmulas de nutrientes indicadas para recém-nascido de alto risco e protetores de mamilo. As frases utilizadas na promoção comercial e na rotulagem dos produtos, inclusive de chupetas e mamadeiras, passaram a ser de advertência do Ministério da Saúde. A rotulagem foi definida para cada tipo de produto, baseada em regras mais restritas. CONCLUSÕES: Foram identificadas importantes modificações no controle do marketing dos produtos dirigidos à mãe no período de lactação. No entanto, ainda há questões legislativas que possibilitariam o aprimoramento da norma brasileira, visando à proteção do aleitamento materno. É necessário também que o governo implante rotinas de monitoramento sistemático de fiscalização dessa legislação.

[Analgesic effects of Emla cream and saccharose solution for subcutaneous injections in preterm newborns: a prospective study of 265 injections]. / Effet analgésique de la crème Emla, du saccharose et de leur association pour les injections sous-cutanées chez le nouveau-né prématuré: étude prospective de 265 injections.

OBJECTIVE: To compare the analgesic effects of non nutritive pacifier sucking, oral administration of a 30% saccharose solution, local application of Emla and their association for subcutaneous injection of erythropoietin (EPO) in preterm infants. METHODS: Our study was a randomised, prospective study conducted over 5 months. Neonates with a gestational age below 33 weeks of gestation and older than 8 days of life were included if they were treated with EPO (three subcutaneous injections per week during 6 weeks). For each consecutive EPO injection, patients were randomised between four groups of intervention: non nutritive pacifier sucking (T), oral administration of 0.2-0.5 ml of a 30% saccharose solution with non nutritive pacifier sucking (S), local application of Emla with non nutritive pacifier sucking (E), and oral administration of 0.2-0.5 ml of a 30% saccharose solution with local application of Emla and with non nutritive pacifier sucking (S + E). Each child was its own control. Pain was assessed with the Newborn Acute Pain scale (DAN) and with the Neonatal Facial Coding System (NFCS). RESULTS: Thirty-three neonates were included, representing 265 injections. Distribution was: 41 in group T, 71 in group E, 86 in group S and 67 in group E + S. Mean DAN and NFCS scores were statistically different between groups T, E and S. Analgesic effect of saccharose (-1.05) was greater than Emla (-0.56). Used together, effects were adding up without potentialisation. CONCLUSION: This study shows that the association of non nutritive pacifier sucking with oral administration of saccharose and local application of Emla has a better analgesic effect than each of these three interventions alone for subcutaneous injection of EPO.