Recommendations from Pediatric and Pediatric Dentistry Associations of the Americas Regarding Pacifier Use

ABSTRACT Objective: To identify online recommendations from pediatric and pediatric dentistry associations of the Americas regarding the pacifier habit. Material and Methods: A search was conducted on the associations' website (November/2021 to March/2023) to the questions: (1) Recommend using a pacifier?, (2) What care?, (3) Advantages and (4) disadvantages, (5) Ideal age, and (6) methods for habit removal. Results: Among the 36 American countries, 21 were represented on websites, social media, and official guides. The most significant portion of pediatric dentistry associations (23.81%) does not recommend the use of a pacifier if the infant is exclusively breastfeeding, and recommends avoiding the offer of a pacifier in the first days of life to facilitate the establishment of breastfeeding. Some pediatric (29.63%) associations suggested that use reduces the risk of sudden infant death syndrome. Most pediatric dentistry associations (85.71%) and some pediatric associations (22.22%) linked pacifier use to breastfeeding difficulties and the occurrence of orthodontics. Most of the 20 pediatric dentistry associations stated that the habit should be removed by a maximum of three years of age (90.48%). The most reported recommendations were behavior modification techniques and positive reinforcement. Conclusion: Most pediatric dentistry associations recommend the care and disadvantages of pacifiers and the ideal age to remove them. The few pediatric associations that provide information address indications, care, advantages and disadvantages of pacifiers, age, and methods for removing them.

Mechanical stress distribution over the palate by different pacifiers assessed by finite element analysis and clinical data.

The mechanical behavior of each type of pacifier on rigid structures and their various impacts on orofacial growth have yet to be discovered. The study aimed to evaluate the stress distribution over a child's palate by three types of pacifiers using finite element analysis and clinical and laboratory data. Modulus of elasticity was obtained from 30 specimens comprising 10 of each conventional (A), orthodontic (B), and breast-shaped (C) pacifiers. Tongue strength was assessed in eight 3-year-old children (kPa). A hemi-maxilla model was obtained from 2- to 3-year-old skull tomography, and the images of pacifiers A, B, and C were captured using 3D scanning. The Hypermesh® program generated a mesh of 6-node tetrahedral elements for applying forces in the X, Y, and Z directions to enable a nonlinear analysis. Pacifier B exhibited the highest values for distributed stress on the palate, followed by pacifier A. Pacifier B stimulated the maxilla forward and sideways. In contrast, pacifier A promoted a forward and upward load, favoring a more atresic palate. Pacifiers A and B tended to rotate in the sagittal plane, generating tensions in the anterior incisors and favoring the open bite. Pacifier C exhibited lateral expansion by stress induction over the mid-palatal suture with less influence on incisor inclination. Pacifiers showed different detrimental stress distributions on the palate. This information can be helpful for improving recommendations given to parents.

Os malefícios da "Luva Chupeta" de látex na Unidade Neonatal / The harmful effects of the latex "Glove Pacifier" in the Neonatal Unit / Los efectos nocivos del "Guante Chupete" de látex em La Unidad Neonatal

Na Iniciativa Hospital Amigo da Criança-Neofoi proposto o uso da chupeta na Unidade Neonatal (UN) de modo terapêutico, e sempre com supervisão de um profissional de saúde. Mas observa-se que o aparato conhecido como "Luva Chupeta" fabricado com o uso de uma luva de látex está sendo utilizado como alternativa para acalentar o recém-nascido (RN). Apesar de poucos estudos, é evidente que esse dispositivo deve ser contraindicado na UN, uma vez que pode provocar alergia ao látex, transmitir infecções, provocar acidentes graves como aspiração laringotraqueal do algodão devido ao rompimento da luva de látex, e dependendo do tamanho do material, obstruir as vias aéreas, e levar a óbito. Além do mais, o dispositivo pode interferir negativamente no crescimento e no desenvolvimento craniofacial e causar prejuízos associados à amamentação e na saúde materno infantil. A substituição da "Luva Chupeta" por outras estratégias, até mesmo pela chupeta convencional ou ortodôntica, para lidar com a dor e situações de estresse do RN deve ser decisiva para evitar os riscos de acidentes graves. O Protocolo de uso de bicos, Protocolo de manejo da dor do RN, adoção do Método Canguru na UN para promoção do desenvolvimento e comportamento do RN, e a capacitação/monitoramento das práticas adotas pela Equipe Materno Infantil, quanto ao cuidado ofertado são alternativas mais complexas, mas que devem ser analisadas por aqueles que desejam oferecer confiabilidade aos seus processos institucionais. (AU)

In the Baby-Friendly Hospital-Neo Initiative, the use of pacifiers in the Neonatal Unit (UN) was proposed in a therapeutic way, and always under the supervision of a health professional. However, it should be noted that the device known as "Pacifier Glove" manufactured using a latex glove is being used as an alternative to cherish the newborn. Despite few studies, it is clear that this device should be contraindicated in the UN, since it can cause allergy to latex, transmit infections, cause serious accidents such as laryngotracheal aspiration of cotton due to the rupture of the latex glove, and depending on the size of the material, obstruct the airways, and lead to death. Furthermore, the device may interfere with craniofacial growth and development and cause harm associated with breastfeeding and maternal and child health. The substitution of the "Pacifier Glove" for other strategies, even for the conventional or orthodontic pacifier, to deal with the pain and stress situations of the baby should be avoided to avoid the risk of serious accidents.The teat use protocol, the baby's pain management protocol, the adoption of the Kangaroo Method in the neonatal unit to promote the baby's development and behavior, and the training/monitoring of the practices adopted by the Maternal and Child Team, regarding the care offered, are alternatives more complex, but which must be analyzed by those who wish to offer reliability to their institutional processes. (AU)

En la Iniciativa Hospital Amigo del Niño-Neo, se propuso terapéuticamente el uso del chupete en la Unidad Neonatal (UN), y siempre bajo la supervisión de un profesional de la salud. Pero se observa que el dispositivo conocido como "chupete Gluva", fabricado con el uso de un guante de látex, está siendo utilizado como una alternativa para cuidar al recién nacido (NB). A pesar de los pocos estudios, es evidente que este dispositivo debe estar contraindicado en la NU, ya que puede causar alergia al látex, transmitir infecciones, ocasionar accidentes graves como aspiración laringotraqueal de algodón por rotura del guante de látex, y dependiendo de la El tamaño del material obstruye las vías respiratorias y provoca la muerte. Además, el dispositivo puede interferir negativamente con el crecimiento y desarrollo craneofacial y causar daños asociados con la lactancia materna y la salud maternoinfantil. La sustitución del "Dummy Glove" por otras estrategias, incluso el chupete convencional u ortodóncico, para hacer frente a las situaciones de dolor y estrés del RN debe ser determinante para evitar el riesgo de accidentes graves. El Protocolo de Uso del Pezón, el Protocolo de Manejo del Dolor del RN, la adopción del Método Canguro en la NU para promover el desarrollo y comportamiento del RN, y la capacitación/seguimiento de las prácticas adoptadas por el Equipo Materno Infantil, en cuanto a los cuidados ofrecidos, son más alternativas eficientes, complejas, pero que deben ser analizadas por quienes deseen brindar confiabilidad a sus procesos institucionales. (AU)

Avaliação da eficácia do acessório mamilo na remoção dos hábitos deletérios / Evaluation of the effectiveness of the nipple accessory in the removal of the deletery habits

Objetivo: avaliar a eficácia do acessório mamilo aplicado a aparelhos ortopédicos/ ortodônticos no tratamento de hábitos deletérios de sucção de chupeta, língua, lábio e dedo, e onicofagia em pacientes tratados nos últimos 20 anos com o aparelho. Métodos: Trata-se de um estudo clínico observacional, retrospectivo, no qual a amostra foi composta de prontuários de pacientes de ambos os gêneros, atendidos por profissionais habilitados pelo aparelho mamilo, que os utilizaram em crianças de 03 a 16 anos portadoras de hábitos deletérios. Os prontuários utilizados, correspondem a pacientes tratados entre os anos 2000 a 2020. Todas as análises foram realizadas no programa R, com nível de significância de 5%. Resultados: Foram analisados 142 prontuários, nos quais 122 foram incluídos, por estarem dentro dos critérios de inclusão propostos no estudo e 20 foram excluídos da pesquisa por apresentarem informações incompletas e/ou não preenchidas corretamente. O hábito com maior incidência foi o de sucção digital, em 71,3% dos pacientes, 91,8% dos pacientes deixaram o hábito, destacando que nos casos de sucção de chupeta e onicofagia, o sucesso na remoção do hábito foi de 100%, em ambos os casos. O tempo médio de uso do aparelho foi de 4,8 meses, variando de 0,6 a 14 meses. O tempo médio para a remoção do hábito após a instalação do aparelho foi de 1,6 meses, variando de 0 a 12 meses. Conclusão: O aparelho mamilo, mostra-se como uma alternativa de alta eficácia na remoção de hábitos deletérios de sução de chupeta, dedo, língua e onicofagia.(AU)

Objective: Evaluate the effectiveness of the nipple accessory applied to orthopedic/orthodontic appliances in the treatment of harmful pacifier, tongue, lip and finger sucking habits, and onychophagia in patients treated in the last 20 years with the device. Methods: This is an observational, retrospective clinical study, in which the sample consisted of medical records of patients of both genders, assisted by professionals qualified by the nipple device, who used them in children aged 03 to 16 years with deleterious habits. The medical records used correspond to patients treated between the years 2000 and 2020. All analyzes were performed in the R program, with a significance level of 5%. Results: 142 medical records were analyzed, in which 122 were included, as they were within the inclusion criteria proposed in the study and 20 were excluded from the research because they presented incomplete information and/or not filled in correctly. The habit with the highest incidence was digital sucking, in 71.3% of patients, 91.8% of patients quit the habit, noting that in cases of pacifier sucking and onychophagia, success in removing the habit was 100%, in both cases. The average time of use of the device was 4.8 months, ranging from 0.6 to 14 months. The mean time to remove the habit after installing the device was 1.6 months, ranging from 0 to 12 months. Conclusion: The nipple device is a highly efficient alternative for removing harmful habits of pacifier, finger, tongue and onychophagy sucking.(AU)

Association between Pacifier Use, Bottle-Feeding, and Pre-Postnatal Variables: A Cohort Study

ABSTRACT Objective: To determine the prevalence and analyze the variables associated with the use of pacifiers and/or bottles by infants up to 6 months of age. Material and Methods: Data on sociodemographic characteristics, intention to offer pacifier and bottle-feeding, pregnancy and breastfeeding (BF) variables were collected at baseline by interviews and a self-administered questionnaire among pregnant women in the 3rd trimester. After delivery, mother-baby binomials were followed by phone calls at the 1st, 3rd, and 6th months of the baby's life (n=467) to gather information on the type of delivery, baby's gender, BF in the first hour of the newborn's life, baby's weight, mother's return to work, and oral habits. Association analyses were performed using logistic regression models with a 5% significance level with the pacifier/bottle-feeding use as the outcome. Results: Most mothers (52.5%) reported their babies used bottle-feeding, 48.2% used pacifiers and 33.4% used both of them throughout the 6 months. Intention to offer pacifier and bottle-feeding was reported by 45.0% and 54.8% of the mothers at the 3rd trimester of the pregnancy, respectively. Not living in one's own residence (OR=1.53; 95%CI: 1.05-2.24) and having the prenatal intention of offering a pacifier (OR=2.50; 95%CI: 1.63-3.83) to the baby were significantly associated with pacifier use. Variables significantly associated with bottle-feeding were mother's return to work (OR=2.48; 95%CI: 1.54-3.97), baby's lower birth weight (OR=1.58; IC95%: 1.07-2.33), and prenatal intention to offer bottle-feeding (OR=2.51; 95%CI 1.56-4.04). Conclusion: About half of the babies used pacifiers or were bottle-fed, which were associated with the mother's prenatal intention to offer them to their babies and socioeconomic factors.

Evaluation of the effect of nutritive versus non-nutritive pacifiers as adjuncts to local anaesthesia in male neonatal circumcision using the plastibell technique - A prospective randomised controlled study.

Background: Male circumcision is the most common surgical procedure worldwide and is often carried out for religious, cultural, medical and public health reasons. It is commonly performed during the neonatal period. Many studies have now shown that pain is a common intra- and post-operative complication. To ensure proper analgesia during the procedure, many surgeons opt for the use of pacifiers as an adjunct to anaesthesia during neonatal circumcision. The aim of this study is to compare nutritive pacifiers (NPs) versus non-NPs (NNPs) as adjuncts to local anaesthesia in male neonatal circumcision using the Plastibell technique. Methods: A prospective randomised controlled study was carried out between October 2019 and March 2020. A total of 100 neonates were circumcised using the Plastibell technique and randomised into NP (Group A, n = 33), NNP (Group B, n = 33) and controls (Group C, n = 34), respectively. The differences in pain scores using the Neonatal Infant Pain Scale, total crying time and heart rate during circumcision were recorded and assessed. Results: The age of participants ranged from 5 to 28 days and the weight ranged from 2.5 to 5.0 kg. The overall mean age, birth weight and current weight of the participants were 15.5 ± 6.1 days, 3.4 ± 0.4 kg and 3.5 ± 0.6 kg, respectively. The control group had the highest average pain score of 5.5 (4.5-5.8) compared to the intervention groups with median pain score (NP: 3.3 [1.3-4.3] and (NNP: 4.3 [3.1-5.1], respectively). NPs had significantly lower pain scores (P = 0.023) and reduced total crying time (P = 0.019) at all stages of the circumcision compared to those given NNPs and controls. Conclusion: This study showed that NPs were superior to NNPs in providing additional pain control during male neonatal circumcision.

Comparison of the effect of two methods of sucking on pacifier and mother's finger on oral feeding behavior in preterm infants: a randomized clinical trial.

BACKGROUND: Oral feeding problems will cause long-term hospitalization of the infant and increase the cost of hospitalization. This study aimed to compare the effect of two methods of sucking on pacifier and mother's finger on oral feeding behavior in preterm infants. METHODS: This single-blind randomized controlled clinical trial was performed in the neonatal intensive care unit of Babol Rouhani Hospital, Iran. 150 preterm infants with the gestational age of 31 to 33 weeks were selected and were divided into three groups of 50 samples using randomized block method, including non-nutritive sucking on mother's finger (A), pacifier (B) and control (C). Infants in groups A and B were stimulated with mother's finger or pacifier three times a day for five minutes before gavage, for ten days exactly. For data collection, demographic characteristics questionnaire and preterm infant breastfeeding behavior scale were used. RESULTS: The mean score of breastfeeding behavior in preterm infants in the three groups of A,B,C was 12.34 ± 3.37, 11.00 ± 3.55, 10.40 ± 4.29 respectively, which had a significant difference between the three groups (p = 0.03). The mean rooting score between three groups of A, B, and C was 1.76 ± 0.47, 1.64 ± 0.48, and 1.40 ± 0.90 (p < 0.001) respectively. Also, the mean sucking score in groups of A, B and C was 2.52 ± 0.76, 2.28 ± 0.64 and 2.02 ± 0.74 respectively, which had a significant difference (p = 0.003), but other scales had no significant difference between the three groups (P > 0.05). The mean time to achieve independent oral feeding between the three groups of A, B, C was 22.12 ± 8.15, 22.54 ± 7.54 and 25.86 ± 7.93 days respectively (p = 0.03), and duration of hospitalization was 25.98 ± 6.78, 27.28 ± 6.20, and 29.36 ± 5.97 days (p = 0.02), which had a significant difference. But there was no significant difference between the two groups of A and B in terms of rooting, sucking, the total score of breastfeeding behavior and time of achieving independent oral feeding (P > 0.05). CONCLUSION: Considering the positive effect of these two methods, especially non-nutritive sucking on mother's finger, on increasing oral feeding behaviors, it is recommended to implement these low-cost methods for preterm infants admitted to neonatal intensive care unit. TRIAL REGISTRATION: Trial Registration: IRCT, IRCT20191116045460N1 . Registered 11 January 2020- prospective registered.

In vitro antimicrobial effects of green tea, microwaving, cold boiled water, and chlorhexidine on Streptococcus mutans and Candida albicans on silicone pacifiers.

Background: This study aimed to compare the antimicrobial effects of green tea, microwaving, cold boiled water, and chlorhexidine (CHX) on Streptococcus mutans and Candida albicans on silicone pacifiers. Materials and Methods: In this in vitro experimental study, 60 equal-size samples of silicone pacifiers were cut, ultraviolet sterilized, and randomly divided into two groups (n = 30) for immersion in 0.5 McFarland standard suspension of S. mutans and C. albicans. The samples in each group were then randomly divided into five subgroups (n = 6) for disinfection with 0.12% CHX, cold boiled water, green tea, microwaving for 7 min, and distilled water. The sample suspensions were cultured on blood agar (for S. mutans) and Sabouraud dextrose agar (for C. albicans) and incubated. The number of colonies was counted after 24 and 48 h. Data were analyzed using the Kruskal-Wallis and Mann-Whitney tests (P < 0.05). Results: At 24 and 48 h, the S. mutans colony count was the lowest in CHX and green tea subgroups followed by microwave, cold boiled water, and distilled water subgroups (P < 0.05). Conclusion: CHX and green tea can significantly decrease the S. mutans and C. albicans colony count on silicone pacifiers.

Prevalence of malocclusion in early childhood and its associated factors in a primary care service in Brazil / Prevalência de maloclusões na primeira infância e fatores associados em um serviço de atenção primária no Brasil

ABSTRACT Purpose to evaluate the prevalence of malocclusion and its associated factors of children cared for by a PHC Service in Porto Alegre, Brazil. Methods a cross-sectional study nested in a cohort, carried out in 12 Health Care Practices. Of the 414 children in the cohort examined, 268 were assessed for malocclusion. The presence of anterior open bite, posterior and anterior crossbite was evaluated by the criteria of Foster and Hamilton. Socioeconomic variables, breastfeeding habits and pacifier use information were collected through a standardized questionnaire. Data analysis was performed using a hierarchical approach by Poisson Regression with robust variance. Results out of the total 268 evaluated, 135 (50.4%) were boys, and the average age was 28.6 (± 11.9) months. Out of the 143 (53.4%) cases of malocclusion, 113 were anterior open bite, 16 were anterior crossbite, 27 were posterior crossbite, and 38 had increased overjet. In the final analysis, it was observed that there was a higher prevalence of malocclusion in children who never breastfed (PR = 1.44; 95%CI 1.00-2.08) and who always used a pacifier to sleep (PR = 1.81; 95%CI 1.14-2.86). Conclusion the prevalence of malocclusion in this population was high and was associated with behavioral habits, such as the use of pacifier and not breastfeeding.

RESUMO Objetivo avaliar a prevalência de maloclusões e seus fatores associados em crianças atendidas em um Serviço de APS de Porto Alegre, Brasil. Método estudo transversal aninhado a uma coorte, realizado em 12 Unidades de Saúde. Das 414 crianças da coorte examinadas, 268 foram examinadas para maloclusão. A presença de mordida aberta anterior, mordida cruzada posterior e anterior foi avaliada pelos critérios de Foster e Hamilton. Variáveis socioeconômicas, hábitos de amamentação e informações sobre o uso de chupeta foram coletados por meio de questionário padronizado. A análise dos dados foi realizada por meio de uma abordagem hierárquica por Regressão de Poisson com variância robusta. Resultados do total de 268 avaliados, 135 (50,4%) eram meninos e a média de idade foi de 28,6 (± 11,9) meses. Dos 143 (53,4%) casos de maloclusão, 113 eram mordida aberta anterior, 16 eram mordida cruzada anterior, 27 eram mordida cruzada posterior e 38 tinham overjet acentuado. Na análise final, observou-se que houve maior prevalência de maloclusões em crianças que nunca foram amamentadas (RP = 1,44; IC95% 1,00-2,08) e que sempre usaram chupeta para dormir (RP = 1,81; IC95% 1,14 -2,86). Conclusão a prevalência de maloclusões nesta população foi elevada e esteve associada a hábitos comportamentais, como o uso de chupeta e a não amamentação.

Evaluation of Effect of Orthodontic Pacifiers in Prevention of Sudden Infant Death Syndrome: A Finite Element Method and Questionnaire Based Study.

INTRODUCTION: Considering the morbidity associated with Sudden Infant Death Syndrome (SIDS) and limitations of absence of such syndrome in animals, a retrospective survey based human study and prospective Finite Element Method (FEM) study was planned to evaluate the effect of orthodontic pacifier in prevention of SIDS. STUDY DESIGN: Two groups, Group I (case) consisting of 48 people, who had lost their infant due to SIDS in past, and Group II (control) consisting of 200 participants with infant in the family, were established. The study was conducted in two parts. An online questionnaire-based survey consisting of 20 multiple choice questions was conducted to establish the correlation of pacifiers in families affected with SIDS. Thereafter, FEM evaluation was carried out in two age groups (up to six months, and between seven to 12 months) with two different pacifiers i.e. conventional and orthodontic, and one human nipples. RESULTS: 12 participants from case group and 170 in control group gave history of using pacifier for their infants between 2 to 6 months. The frequency and duration of use of pacifiers in case group generally increased while infant cried as high as 66 percent in frequency and 75 percent in duration in comparison to 90 percent in control group. FEM analysis showed significant stresses incurred with conventional pacifiers in relation to oral cavity and tongue. Orthodontic pacifiers exhibited human nipple like effect with more pronounced effects on posterior oral cavity and lesser strain on soft and hard tissues. CONCLUSION: Promising results obtained with survey and positive correlation of FEM data with orthodontic pacifiers indicates the superiority and advantages of orthodontic pacifiers in prevention of SIDS.

Cessation of the pacifier sucking habit and self-correction of the anterior open bite in the primary dentition: case report / Interrupção do hábito de sucção de chupeta e autocorreção da mordida aberta anterior na dentição decídua: relato de casos

ABSTRACT Objective: To evaluate the effectiveness of play strategies to break the pacifier-sucking habit and induce self-correction of the anterior open bite in the primary dentition. Methods: Data collection took place at the Pediatric Dentistry clinic of a public education institution. Three children, aged between 3 and 4 years old, using a pacifier and presenting with a 2 to 5 mm anterior open bite, participated in the research. Pediatric dental guidance was imparted to educate the family and to provide play strategies for the child by means of an illustrated book about the pacifier fairy. Results: After the first consultation, two children quit their pacifier habit. Subsequent consultations were devoted to positive reinforcement and follow-up of the self-correction of the anterior open bite. The third child required four visits to stop the pacifier habit, but other habits persisted and the open bite was only corrected after intervention by a multidisciplinary team. Conclusions: After receiving orientation from the professionals, the parents/guardians cooperated in stimulating the child, and the play activities were effective in encouraging the child to stop sucking on the pacifier, permitting self-correction of the anterior open bite. Bottle feeding, tongue interposition and mouth breathing may hinder the spontaneous correction of the anterior open bite after the pacifier habit is abandoned, requiring multidisciplinary intervention.

RESUMO Objetivo: Avaliar a eficácia de estratégias lúdicas para interrupção do hábito de sucção de chupeta e a autocorreção da mordida aberta anterior na dentição decídua. Métodos: A coleta dos dados ocorreu na clínica de Odontopediatria de uma instituição pública de ensino. Participaram 03 crianças, de 3-4 anos de idade, em uso de chupeta e apresentando mordida aberta anterior. Foi efetuada orientação para conscientização da família e estratégias lúdicas para a criança, com um livro ilustrado sobre a fada da chupeta. Resultados: Após primeiro atendimento, duas crianças interromperam o hábito de chupeta. As consultas seguintes foram para reforço positivo e acompanhamento da autocorreção da mordida aberta anterior. A terceira criança necessitou de quatro atendimentos para interromper o hábito da chupeta, porém outros hábitos persistiram e a correção da mordida aberta ocorreu após intervenções da equipe multidisciplinar. Conclusão: Após orientação profissional, os pais/responsáveis colaboraram para estimular a criança e os recursos lúdicos foram eficientes para incentivar a criança a interromper a sucção de chupeta, possibilitando autocorreção da mordida aberta anterior. Uso de mamadeira, interposição lingual e respiração bucal podem dificultar a correção espontânea desta má oclusão após abandono da chupeta, sendo necessária intervenção multidisciplinar.

Malocclusion and Associated Factors in Early Childhood and Knowledge Level of Mothers from Childcare Groups

ABSTRACT Objective: To determine the prevalence of malocclusion and associated factors in children and the level of knowledge of mothers participating in the child care group of a basic health unit. Material and Methods: This is a cross-sectional study conducted in children between 18 and 72 months of a childcare group in Pelotas. Children whose parents or legal guardians signed the informed consent term participated in the study. Data were collected through a questionnaire previously tested and applied to the mothers, and a clinical examination of children's occlusion were performed by examiners after training and calibration. Statistical analysis was descriptive and analytic. In the bivariate analyses, it was used the Pearson, Fisher or Linear Trend Qui-Square tests and, in the multivariate analysis, the Poisson regression. Prevalence ratios and 95% confidence intervals were obtained, and a p-value <0.05 was used. Results: Forty-seven children were included and 41.3% presented malocclusion. The prevalence of malocclusion was associated with a higher number of children in the family (p<0.005) and breastfeeding for more than 12 months (p<0.05). The highest prevalence of open bite was associated with the use of a pacifier and working mothers (p<0.05). Conclusion: Most mothers reported having knowledge about the time and use of pacifiers in childhood. In this group, the prevalence of malocclusion in children was high and associated with behavioral and social factors.

Mothers' false beliefs and myths associated with teething.

BACKGROUND: Teething is a physiological process experienced by all children. However, many unrelated illnesses are blamed on teething. OBJECTIVE: The aim of this study was to assess mothers' beliefs toward teething and to investigate the practices preferred by mothers to alleviate symptoms that might accompany the teething process. METHODS: A cross-sectional study was conducted in Basra. The study population includes mothers of young children aged (6-30) months who had at least one erupted primary tooth, and who had no history of medical or systemic disease that might affect teething. Two hundred mothers of different age groups and educational backgrounds responded to a questionnaire that included information on the child's age and birth order, mother's age, level of education, occupation, number of children, beliefs toward teething symptoms, and the practices preferred to relieve the attributed symptoms. Data has been presented in numbers and percentages, the Chi-square test was performed where appropriate, and a p value of < 0.05 was considered significant. RESULTS: All (100%) participants attributed at least one symptom or sign to the teething process. The most common symptoms reported were fever (70%), diarrhea (68.5%), and sleep disturbance (63.5%). Sixty-eight percent of mothers believed teething remedies were effective; only 10 (5%) did not give any treatment. Over half (62%) gave medications, such as antipyretics, antibiotics, and antidiarrheal agents. Some used teething gels (29%), pacifiers (50%), gum massage (22%), and hard foods such as biscuits and carrots (43.5%). Mothers of various educational levels reported attributed symptoms, and the result was statistically significant (p < 0.05). Mothers of a firstborn child were found to have a higher tendency to attribute symptoms to teething than those who had previous experience with children (p < 0.05). DISCUSSION AND CONCLUSIONS: Teething myths and misconceptions are common among mothers. The study identified a significant number of doctors, dentists, and pharmacists still attribute many symptoms and signs to teething despite the lack of supporting evidence. Therefore, the findings of this study highlight the need for continuous medical education and nationwide prospective studies to eradicate these false beliefs.

Uso de chupeta e a interrupção do aleitamento materno exclusivo: estudo de coorte / Pacifier use and interruption of exclusive breastfeeding: a cohort study / Uso de chupete e interrupción de lactancia materna exclusiva: estudio de cohorte

Este estudo se propôs a averiguar a existência de associação entre o uso de chupeta e a interrupção precoce do aleitamento materno exclusivo (AME) ao longo dos quatro primeiros meses de vida da criança. Para isso, utilizaram-se dados de uma coorte composta por 1.037 mães e crianças. Para estimar a associação entre a variável desfecho e aquelas de exposição ao longo do tempo, foi utilizada a técnica de Equação de Estimação Generalizada (GEE). Foi averiguado que a interrupção precoce do AME e o uso de chupeta aumentaram gradativamente conforme a idade da criança; no quarto mês, mais da metade das crianças já estava desmamada e fazia uso de chupeta. Os resultados da estimativa obtida por meio da GEE mostraram que permaneceu significativo apenas o uso de chupeta associado à baixa escolaridade materna como risco de interrupção precoce do AME, quando ajustado para as demais covariáveis. Os resultados reforçam a interferência negativa do uso da chupeta na duração do AME e a necessidade de informar às mães sobre as desvantagens do uso de chupetas.

This study investigates the possible association between pacifier use and early termination of exclusive breastfeeding for four months following birth. Data was collected from a cohort comprising1037 mothers and children. The association between the outcome variable and the exposure variables over time was estimated using the Generalized Estimation Equation (GEE). Early weaning and pacifier use increased gradually with the child's age; by the fourth month, more than half of the children were already weaned and using a pacifier. GEE estimations showed that only pacifier use associated with low maternal schooling level remained significant as a risk of early weaning, when adjusted for the other covariates. The results reinforce the negative interference of pacifier use on EB duration and the need to inform mothers about the disadvantages of pacifier use.

Este estudio tuvo como objetivo investigar la existencia de una asociación entre el uso de chupete y la interrupción temprana de la lactancia materna exclusiva (LME) durante los primeros cuatro meses de vida del niño. Se utilizaron datos de una cohorte, compuesta por 1.037 madres y niños. Para estimar la asociación entre la variable resultado y las de exposición en el tiempo, se utilizó la técnica de Ecuación de Estimación Generalizada (GEI). La interrupción temprana de la LME y el uso de un chupete aumentaron gradualmente conforme a la edad del niño; en el cuarto mes, más de la mitad de los niños ya habían sido destetados y usaban chupete. Los resultados de la estimación obtenida a través de GEI mostraron que solo el uso de chupetes asociado a bajos niveles de educación materna permaneció significativo como riesgo de interrupción temprana de la LME, cuando se ajustó con las otras covariables. Los resultados apuntan la interferencia negativa del uso de chupete en la duración de la LME y la necesidad de informar a las madres sobre las desventajas del uso de chupete.

The Novel Coronavirus: An Alert for Pacifiers' Disinfection

Objective: To evaluate the best strategy for pacifier disinfection methods. Material and Methods: The literature search was conducted on MEDLINE/PubMed, Scielo, Lilacs, Web of Science, and Scopus databases to find all relevant articles published over the past 20 years, based on PRISMA guidelines. Two reviewers extracted data independently by using a standardized form. The following factors were recorded: country of study, type of study, pacifier material, sample number, microorganisms analyzed, decontamination methods used, method accessibility and results found. Results: A total of 121 articles were obtained from all databases. The selected documents underwent a final screening, resulting in 8 articles. The method of disinfection analyzed by the literature were: 3.5% neutral detergent, apple cider vinegar 70% spray, boiling water during 15 minutes, sodium hypochlorite 2.5, hydrogen peroxide 70% spray, chlorhexidine 0.12%, Brushtox®, sterile water and microwave. Conclusion: Because of the broad methods for pacifier disinfection and different levels of accessibility to disinfectant agents, the pacifier consensus for decontamination remains unclear. Although the disinfection methods are diverse, the methods suggested to its disinfection were identified and described in this article.

Use of Artificial Nipples Among Brazilian Infants and Associated Factors.

Transversal study conducted in a Human Milk Bank to evaluate the factors associated with the use of artificial nipples (pacifier and/or nursing bottle) among Brazilian infants. Analyses were performed using the χ2 test and logistic regression analysis. A total of 6017 nursing mothers were evaluated and the use of artificial nipples was reported by 31.3%. The chance of using artificial nipples was higher among infants whose mothers attended antenatal care in private hospitals [odds ratio (OR): 1.61, 95% confidence interval (CI) 1.21-2.14], born in maternities without the Baby-Friendly Hospital Initiative (BFHI) (OR: 18.38, 95% CI 13.50-25.04) and those with adequate birth weight (OR: 2.83, 95% CI 1.99-4.03). A lower chance of using artificial nipples was observed among infants whose mothers had previous breastfeeding experience (OR: 0.76, 95% CI 0.61-0.95), received guidance on breastfeeding during antenatal care (OR: 0.80, 95% CI 0.65-0.98), practiced exclusive breastfeeding (OR: 0.36, 95% CI 0.28-0.45), breastfeeding on demand (OR: 0.66, 95% CI 0.52-0.85) and residents of inland cities/towns (OR: 0.38, 95% CI 0.20-0.72). The findings highlight the importance of breastfeeding guidance during antenatal care and the role of BFHI in clarifying risks associated with artificial nipple use.

Frequency and Predictors of Pacifier Use in the Low Socioeconomic Group of Karachi, Pakistan: A Cross-Sectional Study.

Background Pacifier use has been popular for ages. They are prevalent all over the world because of their various perceived benefits. On the other hand, there is a common belief that they do carry health risks as well. Due to these contradicting belief systems, the frequency of their use, and the factors that determine them, need to be thoroughly evaluated. Since Pakistan is a developing country with a low literacy rate, it can be implied that a vast majority of the country's population may lack awareness regarding the advantages and disadvantages of pacifier use, making them incapable of weighing associated risks versus benefits. The data evaluating these factors in this region are however scarce in the published literature. We, therefore, aimed to highlight the frequency and predictors of pacifier use in the low socioeconomic group of Karachi, Pakistan. Materials and methods A descriptive, cross-sectional study was conducted on a sample of 300 mothers visiting a tertiary care hospital in Karachi, Pakistan. We included mothers who had at least one child under the age of two years, and whose child did not have any oro-nasal anomaly that could prevent them from sucking a pacifier. Data were collected using pre-tested questionnaires and analyzed using the Statistical Package for Social Sciences (SPSS version 23.0, IBM Corp., Armonk, NY, US). Frequencies were calculated and presented in the form of tables. The chi-square test was used to determine the significance of all categorical variables. A P-value of <0.05 was considered to be statistically significant. Results Almost half of our respondents (49%) gave pacifiers to their children. A significant number (59%) of these mothers were uneducated. Almost all (97%) of the users had annual household income less than 15,000 Pakistani rupees (PKR); 34% were primiparous and more than two-thirds (71%) had a normal vaginal delivery. Out of all the factors, maternal age less than 20, annual household income less than 15,000 PKR, and primiparity were significantly associated with pacifier use in mothers (P<0.05). Only a half of the users (51%) cleaned the pacifiers by boiling; one-fourth (25%) washed it with water only; while 18% washed it with soap and water. The majority (84%) of the mothers used the pacifier to soothe the baby when upset. Among mothers who did not use a pacifier, about a third (30%) did not do so as they believed it's a bad practice. About one-fourth (27%) believed it was unhygienic. Conclusions Our study highlights the gap in the awareness of mothers regarding pacifier use. Using this data, we can target to disseminate specific information to this population to integrate safe and healthy child care habits in society.

Pacifier Use and Breastfeeding: A Qualitative Study of Postpartum Mothers.

Objective: Due to the inconclusive evidence supporting the traditional recommendation to avoid early pacifier use among breastfeeding newborns, this study aims to understand what information mothers are receiving from hospital based care providers and their perspectives about pacifier use in the newborn period. Methods: Interviews with mothers of healthy, term newborns during the postpartum hospitalization were conducted in this qualitative study. Results: Qualitative data analysis yielded several major themes that included the following: (1) pacifiers are beneficial for the maternal/infant experience, (2) concerns that pacifiers may interfere with breastfeeding, and (3) concerns about long-term use (including reliance and effect on teeth). Conclusion: Given the maternal perception of benefit and the paucity of high-quality evidence showing harm, further research on the effects of early pacifier use is needed.

Types of Feeding and Presence of Harmful Oral Habits in Children with Cleft Lip and/or Palate: A Pilot Study

Abstract Objective: To verify the relationship between the types of feeding and presence of harmful oral habits (HOH) in children with cleft lip (CL), palate (CP) and cleft lip and palate (CLP), as well as to compare the different types of cleft to each other. Material and Methods: A form was applied to the parents of 162 children (3-5 years old), addressing the following variables: gender, cleft type, age, socioeconomic conditions, type of breastfeeding, presence of HOH, and the parents' knowledge about the consequences of oral habits. The data obtained were analyzed by chi-square test (p<0.05). Results: The majority of children (83.3%) were bottle-fed and 12.3% were exclusively maternal breastfed. The main reason for weaning was the presence of cleft (59.9%). Breastfeeding was significantly higher in children with CL (75%) in comparison with CP (20%) and CLP (5%) (p<0.001). Children with CLP were 12 times more likely to be bottle-fed than children with CL (OR=12.21; CI=4.09-36.45). The prevalence of HOH was 37%. Sociodemographic characteristics were not associated with the presence of HOH (p>0.05). The type of feeding and cleft were not decisive to present some type of HOH (p>0.05) and 87% of parents stated that HOH could lead to serious complications of tooth misalignment. Conclusion: The type of feeding and fissure did not determine the acquisition of harmful oral habits in children with cleft. However, the greater the fissure's complexity, the lesser the chance of children receiving exclusive breastfeeding.

Illegal commercial promotion of products competing with breastfeeding / Promoção comercial ilegal de produtos que competem com o aleitamento materno

ABSTRACT OBJECTIVE To assess if the commercialization of infant formulas, baby bottles, bottle nipples, pacifiers and nipple protectors is performed in compliance with the Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância e de Produtos de Puericultura Correlatos (NBCAL - Brazilian Code of Marketing of Infant and Toddlers Food and Childcare-related products). The commercial promotion of these products is prohibited by the Law 11,265. METHOD Cross-sectional study conducted in 2017 through a census of all pharmacies, supermarkets and department stores that sold products covered by NBCAL in the South Zone of Rio de Janeiro. Health professionals trained at NBCAL used structured electronic form for direct observation of establishments and for interviews with their managers. We created indicators to evaluate commercial practices and performed descriptive analyses. RESULTS A total of 352 commercial establishments were evaluated: 240 pharmacies, 88 supermarkets and 24 department stores, of which 88% sold products whose promotion is prohibited by NBCAL. Illegal commercial promotions were found in 20.3% of the establishments that sold the products we investigated: 52 pharmacies (21.9%), four supermarkets (7.5%) and seven department stores (33.3%). The most frequent commercial promotion strategies were discounts (13.2%) and special exposures (9.3%). The products with the highest prevalence of infractions of NBCAL were infant formulas (16.0%). We interviewed 309 managers of commercial establishments; 50.8% reported unfamiliarity with the law. More than three-quarters of the managers reported having been visited at the establishments by commercial representatives of companies that produce infant formulas. CONCLUSION More than a fifth of commercial establishments promoted infant formulas, baby bottles and nipples, although this practice has been banned in Brazil for thirty years. We think it is necessary to train those managers. Government agencies must monitor commercial establishments in order to inhibit strategies of persuasion and induction to sales of these products, ensuring mothers' autonomy in the decision on the feeding of their children.

RESUMO OBJETIVO Avaliar se a comercialização de fórmulas infantis, mamadeiras, bicos, chupetas e protetores de mamilo é realizada em cumprimento com a Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância e de Produtos de Puericultura Correlatos (NBCAL). A promoção comercial desses produtos é proibida pela Lei 11.265. MÉTODOS Estudo transversal conduzido em 2017 por meio de um censo de todas as farmácias, supermercados e lojas de departamento que comercializavam produtos abrangidos pela NBCAL na Zona Sul do Rio de Janeiro. Profissionais de saúde capacitados na NBCAL utilizaram formulário eletrônico estruturado para observação direta dos estabelecimentos e para entrevista com seus responsáveis. Foram criados seis indicadores de avaliação das práticas comerciais e realizadas análises descritivas. RESULTADOS Foram avaliados 352 estabelecimentos comerciais: 240 farmácias, 88 supermercados e 24 lojas de departamento, dos quais 88% comercializavam produtos cuja promoção é proibida pela NBCAL. Foram encontradas promoções comerciais ilegais em 20,3% daqueles que comercializavam os produtos investigados: 52 farmácias (21,9%), quatro supermercados (7,5%) e sete lojas de departamento (33,3%). As estratégias de promoção comercial mais frequentes foram os descontos (13,2%) e as exposições especiais (9,3%). Os produtos com maior prevalência de infrações à NBCAL foram as fórmulas infantis (16,0%). Foram entrevistados 309 responsáveis por estabelecimentos comerciais, 50,8% relatando não conhecer a lei. Mais de três quartos dos responsáveis relataram receber visitas nos estabelecimentos de representantes comerciais de empresas fabricantes de fórmulas infantis. CONCLUSÃO Mais de um quinto dos estabelecimentos comerciais faziam promoção comercial de fórmulas infantis para lactentes, mamadeiras e bicos, apesar de essa prática ser proibida no Brasil há trinta anos. É necessária a capacitação dos seus responsáveis. Os órgãos governamentais devem realizar fiscalização dos estabelecimentos comerciais para coibir estratégias de persuasão e indução à vendas desses produtos, garantindo às mães autonomia na decisão sobre a alimentação de seus filhos.