Deformational plagiocephaly: a follow-up of head shape, parental concern and neurodevelopment at ages 3 and 4 years.

OBJECTIVES: To compare head shape measurements, parental concern about head shape and developmental delays in infancy with measurements obtained at follow-up at ages 3 and 4 years. DESIGN: Longitudinal cohort study. SETTING: Initial assessments were conducted at a plagiocephaly clinic; follow-up assessments were conducted in the children's homes. PARTICIPANTS: 129 children with a mean age of 4 years (range 3 years 3 months to 4 years 9 months), all of whom were diagnosed in infancy with deformational plagiocephaly or brachycephaly. MAIN OUTCOME MEASURES: Head shape measurements of cephalic index and oblique cranial length ratio; level of parental concern about head shape; and delays on parent-completed age-appropriate Ages and Stages Questionnaires. RESULTS: 61% of head shape measurements reverted to the normal range; 4% remained severe at follow-up. Brachycephaly improved more than plagiocephaly. Facial and frontal asymmetry reduced to almost nil. Most had good improvement, but 13% were categorised as having 'poor improvement'. Initially, 85% of parents reported being 'somewhat' or 'very' concerned; this decreased to 13% at follow-up. The percentage of children with ≥1 delay decreased from 41% initially to 11% at follow-up. CONCLUSIONS: Overall, head shape measurements, parental concern and developmental delays in infancy showed a dramatic improvement when re-measured at 3 and 4 years of age.

Characteristics, head shape measurements and developmental delay in 287 consecutive infants attending a plagiocephaly clinic.

AIM: To describe the characteristics, developmental status and severity of head shape deformation in infants presenting to a plagiocephaly clinic. METHODS: Head shape was measured and neck function assessed in 287 consecutive infants presenting to a plagiocephaly outpatient clinic. Information was obtained on demographic and obstetric factors, plagiocephaly history and current positioning strategies. Development was assessed by the Ages and Stages Questionnaire (ASQ). RESULTS: After clinical examination, craniosynostosis was suspected in seven infants (2%) and a skull computed tomography (CT) scan was performed; five showed suture abnormalities. Fifty-eight percent of cases had a history of limitation of neck function; this was more likely in plagiocephalic infants than brachycephalic infants. Males, firstborn infants, instrument-delivered infants, supine sleep position and right-sided flattening were predominant. One or more delays on the ASQ were seen in 36% of infants. CONCLUSION: Physical examination of infants with head shape deformities is essential in order to rule out craniosynostosis. Infants with deformational plagiocephaly frequently have neck muscle dysfunction. We postulate that the higher than expected number of developmental delays may be related to the effects of supine sleep position, low or variable tone, lower activity levels, male gender and neck muscle dysfunction.

The impact of pacifier use on breastfeeding: a prospective cohort study.

OBJECTIVES: To determine the predictors of pacifier use during the first year of life and to assess the influence of pacifier use on the duration of breastfeeding. METHODOLOGY: A prospective cohort study was conducted. Three hundred and fifty mother-infant pairs were followed to 1 year of age to determine the impact of the use of a pacifier on the duration of breastfeeding. RESULTS: A cohort of 441 mothers were enrolled and 79% participated. Ninety four per cent were followed up to 1 year. Daily pacifier use was associated with early cessation of breastfeeding (risk ratio (RR) 1.71; 95% confidence interval (95%CI) 1.29, 2.28) and a reduced duration of full breastfeeding (adjusted (adj.) RR 1.35; 95%CI 1.05, 1.74). Finger sucking was not associated with a reduced duration of breastfeeding (RR 1.05; 95%CI 0.81, 1.37). Pacifier use less than daily was not associated with a change in duration of breastfeeding (RR 1.02; 95%CI 0.75, 1.39). Most mothers commenced the use of a pacifier within the first month. Multiple logistic regression analysis found that the use of a pacifier was associated with male gender (adj. RR 1.97; 95%CI 1.23, 3.13), maternal smoking in pregnancy (adj. RR 2.23; 95%CI 1.01, 4.95), and low maternal confidence with breastfeeding (adj. RR 2.70; 95%CI 1.48, 4.93). CONCLUSIONS: Daily pacifier use is associated with a reduced duration of breastfeeding. Less frequent pacifier use does not reduce the duration of breastfeeding.

Mastitis in the first year postpartum.

BACKGROUND: Limited information is available about the frequency and risk factors for lactation mastitis. The purpose of this study was to investigate frequency, risk factors, and outcome for lactation mastitis. METHODS: We analyzed data from a cohort study of 350 mothers with healthy term infants, who were followed up for one year postpartum. RESULTS: Eighty-three women (23.7% of the sample) reported one or more episodes of mastitis symptoms, and 61 (17.4%) women reported symptoms including fever. Fifty-six women (16%) received one or more courses of antibiotics for mastitis. Thirty women (8.5%) of the total cohort had recurrent episodes of mastitis symptoms. A total of 123 episodes of mastitis symptoms were reported. No cases of abscess were reported. Using multiple logistic regression, the adjusted risk ratio for mastitis symptoms associated with sore nipples in the first month was 2.07 (95% CI = 1.17, 3.66). A reduced risk of mastitis was associated with maternal smoking during pregnancy, with supplementation with water in the first month, and with the use of a pacifier on a daily basis within the first month. A history of mastitis symptoms was associated with a longer overall duration of breastfeeding. CONCLUSIONS: Our results suggest that mastitis may be a marker for an ample milk supply. Mothers presenting with mastitis can be reassured that the outlook for continued successful lactation is good. Further research is needed to investigate the reasons for recurrence of mastitis and the etiology of episodes occurring late in lactation.

Factors associated with the duration of breastfeeding.

A cohort study of healthy term infants was conducted to identify factors associated with breastfeeding duration. Three hundred and fifty mothers delivering in one obstetric hospital in Auckland, New Zealand were recruited. Ninety-five percent were followed up until 1 y. Breastfeeding was initiated by 97.4%, the median duration of breastfeeding was 7.6 mo, and 30% were continuing some breastfeeding at 12 mo. Adjusted risk ratios for shorter duration of breastfeeding were: maternal age <25 y, 2.33 (95% confidence interval = 1.33, 4.05); maternal age 25-34, 1.45 (1.01, 2.09) compared to maternal age > or =35; planning to cease breastfeeding < or =6 mo, 2.39 (1.65, 3.46); planning to breastfeed for as long as possible, 1.48 (1.00, 2.18), or not knowing plans 2.13 (1.36, 3.32) when compared to planning to cease breastfeeding after 6 mo; inverted nipples, 2.02 (1.26, 3.23), daily dummy use 1.62 (1.20, 2.18) or use of formula in the first month 2.79 (2.05, 3.80). Reporting mastitis, 0.67 (0.48, 0.94), and sharing the mother's bedroom at 3 mo, 0.69 (0.51, 0.92) were associated with a reduced risk for shorter duration of breastfeeding. We recommend that during the antenatal period attention be directed at mothers' plans for duration of breastfeeding, that mothers be encouraged to have their baby in their bedroom, and that the use of formula and dummies should be discouraged in the first months of life.