Breastfeeding and pacifier use in Brazil

Factors associated with pacifier use among children of working women with childcare in the workplace

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.

Pacifier Use and Exclusive Breastfeeding in Brazil

BACKGROUND

Exclusive breastfeeding (EBF) rates for infants younger than 6 months have increased in Brazil, although at the current pace of improvement it would take 6 years to reach an EBF rate of 50%. Thus, it is important to identify relevant modifiable key risk factors for the premature interruption of EBF.

OBJECTIVE

This study aimed to find out if pacifier use is an independent risk factor for the interruption of EBF among Brazilian infants.

METHODS

We conducted secondary cross-sectional data analyses of 2 waves of infant feeding surveys conducted in 1999 and in 2008 in the Brazilian state capitals and Federal District (N = 42 395 children < 6 months). Multivariate logistic regression was used to test the association between pacifier use and the risk of interruption of EBF in a pooled sample and within each survey wave, adjusting for socioeconomic, demographic, and biomedical confounders.

RESULTS

In the pooled sample, a third of the infants were exclusively breastfed (32.7%) and almost 50% had used a pacifier. Whereas EBF prevalence among infants increased from 25.1% in 1999 to 40.3% in 2008, pacifier use prevalence decreased from 58.5% to 41.6% in the same time period. Pacifier use was strongly associated with the risk of interruption of EBF in 1999 (adjusted odds ratio [AOR] = 2.65; 95% confidence interval [CI], 2.38-2.94), in 2008 (AOR = 3.18; 95% CI, 2.81-3.60), and in the pooled sample (AOR = 2.77; 95% CI, 2.63-2.91) after adjusting for key confounders.

CONCLUSION

Pacifier use was the strongest risk factor for EBF interruption. Effective strategies to reduce pacifier use among infants younger than 6 months may further improve EBF rates in Brazil.

Weaning and associated factors in children from low-income communities

Introduction: The average duration of breastfeeding is still insufficient and differ widely taking in account the location and specific characteristic of local people involved in these studies. Aim: This research aimed at studying factors associated to weaning among South Brazilian children living in a low-income household. Material and method: Cross-sectional study was carried out enrolling 124 mothers of 1 to 12-month-old children, who were interviewed at "Pastoral da Criança" (non-governmental organization) in Almirante Tamandaré, Paraná, Brazil. The risk of weaning considered was the dependent variable and the information collected from the questionnaires, independent variables. The method used to collect information in this study was Kaplan-Meier method and Cox regression model and Spearman's rank correlation (α = 0.05). Result: Actuarial life table presented a higher weaning conditional probability at 12 months of age, followed by first and fourth months of age. Multivariate analysis pointed out that contact with bottle feeding before the sixth month of age [HR=17.16 (2.34-125.86)] and contact with pacifier before the sixth months of age [HR=3.48 (1.90-6.38)] are risk factors associated with weaning. Among children who were not breastfed at the moment of the interview, breastfeeding duration presented a positive correlation with the ages when the children had their first contact with sugar (r s =+0.419, p=0.001) and negative correlation with the use of pacifier (r s =-0.300, p=0.017). Conclusion: Results from this study showed that the use of the feeding bottle and pacifier were related to a shorter breastfeeding time span at these communities.

Fatores determinantes do uso de chupeta entre crianças participantes de programa de incentivo ao aleitamento materno

Objetivo avaliar a introdução de chupeta entre crianças assistidas por um programa interdisciplinar de incentivo ao aleitamento materno durante os primeiros seis meses de vida, investigando os possíveis determinantes do seu uso. Métodos foi realizado um estudo descritivo, exploratório, longitudinal, quantitativo, por meio do acompanhamento de 120 díades mãe-crianças. Foram coletados dados sobre características pessoais, demográficas, e variáveis referentes aos períodos pré, peri e pós-natal. Foram realizadas análises bivariadas pelo teste Qui-quadrado e teste Exato de Fisher e análise de regressão múltipla de Poisson com ajuste robusto do erro padrão. Resultados verificou-se que 13,33% das crianças usavam chupeta ao final do primeiro mês de vida e que 23,33% apresentavam este hábito ao término do sexto mês. O uso de chupeta esteve associado positivamente à ausência de aleitamento materno exclusivo ao final do primeiro mês (RP:5,44; IC95%:2,38-12,44). Ao final do sexto mês, mostrou-se associado à ausência de aleitamento materno exclusivo no momento da alta hospitalar (RP:4,91; IC95%:1,79-13,48) e ausência de aleitamento materno exclusivo aos seis meses de vida (RP:2,32; IC95%:1,32-4,08). Conclusão o uso de chupeta durante os primeiros seis meses de vida entre crianças assistidas por um programa de promoção à amamentação mostrou-se associado à ausência de aleitamento materno exclusivo.

Advising mothers about breastfeeding and weaning reduced pacifier use in the first year of life: a randomized trial

OBJECTIVE

To assess the effectiveness of home visits for advising mothers about breastfeeding and weaning on pacifier use in the first year of life.

METHOD

A randomized field trial was conducted on mothers who gave birth within the public health system in the Brazilian city of Sao Leopoldo (intervention group = 200; controls = 300). The intervention group received the advice 10 days after the child's birth, monthly up to 6 months, at 8, 10, and 12 months, based on the 'Ten Steps for Healthy Feeding', a Brazilian national health policy for primary care, which follows WHO guidelines. Relative risk (RR) was used to estimate the effects of the intervention on the risk of using a pacifier.

RESULTS

55.4% of the children in the intervention group and 66.1% of the controls used a pacifier in the first year of life. The risk of using a pacifier was 16% lower for the intervention group (RR = 0.84; 95% CI, 0.71-0.99). A multivariable Poisson regression model showed higher adjusted risk of using a pacifier for children who had breastfeeding interrupted in the first month of life (RR = 1.43; 95% CI, 1.21-1.69) and whose mothers presented higher level of depression (RR = 1.40; 95% CI, 1.17-1.66).

CONCLUSIONS

Pacifier use is highly prevalent in the population studied. The home visits for dietary advice appear to help in reducing pacifier use in infants. These findings suggest the need for public health strategies that address early advice on pacifier use to promote child oral and general health.

[Determinants of the exclusive breastfeeding abandonment in children assisted by interdisciplinary program on breast feeding promotion]

OBJECTIVES

To identify variables potentially related with the exclusive breastfeeding abandonment in children assisted by interdisciplinary program on breast feeding promotion.

METHODS

Data were collected by a longitudinal study with 111 mothers who breastfeed their children until six months of age. Univariate analyses were used to assess factors associated with the exclusive breastfeeding abandonment, and also multiple regression analyses.

RESULTS

The mothers were divided in two groups: 57 mothers breastfeed, exclusively, their children until six months of age and 54 mothers introduced other kinds of food before this age. The following variables were found to be factors associated with the exclusive breastfeeding abandonment: pacifier use (OR 4,65; IC95% 1,66-12,99), social and economic high level (OR 11,46; IC95% 3,09-42,37) and mother's work (OR 2,44; IC95% 0,91-5,62).

CONCLUSION

Pacifier use, social and economic high level and mother's work are associated with the exclusive breastfeeding abandonment.

Fatores de risco associados ao desmame em crianças até seis meses de idade no município de São Paulo

OBJETIVO: Avaliar os fatores de risco associados à ausência de aleitamento materno exclusivo (AME) em crianças <6 meses de vida na cidade de São Paulo, em 2008. MÉTODOS: Aplicou-se o questionário do Projeto Amamentação e Municípios-1998 (AMAMUNIC) a pais/responsáveis de crianças <6 meses de idade durante a Campanha Nacional de Vacinação contra Poliomielite. Cálculo da amostra por conglomerados com sorteio em dois estágios. Os fatores analisados foram idade e educação materna, peso de nascimento, sexo, tipo de parto, nascer em Hospital Amigo da Criança, presença de aleitamento materno precoce, uso de chupeta nas últimas 24 horas e mãe trabalhando fora de casa. Análise estatística por regressão logística binária com SPSS, versão 15.0, sendo significante p<0,05. RESULTADOS: Foram realizadas 724 entrevistas, das quais 275 referiram (39,1%) aleitamento materno exclusivo (Grupo I - GI) e 429 (60,9%) sem aleitamento materno exclusivo (Grupo II - GII). Houve diferenças entre os grupos quanto ao uso da chupeta nas últimas 24 horas (GI 32,3 versus GII 59,8%; p<0.001), mães trabalhando fora (GI 12,4 versus GII 24,8%; p<0.001) e idade da criança (GI 74,1±45,3 versus GII 105,8±49,5 dias; p<0,0001).Na análise multivariada, houve associação entre ausência de aleitamento materno exclusivo e uso de chupeta (OR 3,02; IC95% 2,10-4,36), mãe trabalhando fora (OR 2,11; IC95% 1,24-3,57) e idade da criança (OR 1,01; IC95% 1,01-1,02). CONCLUSÕES: O uso da chupeta nas últimas 24 horas associou-se à ausência de AME em crianças menores do que seis meses, seguido pelo trabalho materno fora de casa e pela idade da criança, que são importantes fatores a serem controlados em programas de promoção do aleitamento materno.

Exclusive breastfeeding in southern Brazil: prevalence and associated factors

BACKGROUND

Worldwide strategies have been conducted in order to guarantee longer periods of exclusive breastfeeding for most children, especially those from developing countries. The evaluation of infant feeding practices and the identification of weaning risk factors are essential for public health policy planning.

METHODS

This cross-sectional study was carried out in Joinville, the biggest city of Santa Catarina State in the southern Brazilian region. The caregivers of children under 1 year of age were systematically selected for interview in previously drawn immunization units during the 2005 National Vaccination Campaign. A structured questionnaire was applied for collection of infant, maternal, and healthcare variables. A 24-hour food recall survey was included in order to evaluate infant feeding practices. Descriptive statistic analysis on breastfeeding prevalence and Poisson regression analysis of risk factors for discontinuing exclusive breastfeeding for infants up to 6 months of age were performed.

RESULTS

Caregivers of 1,470 infants were interviewed. The feeding inquiry showed an overall rate of breastfeeding of 72.5% and a frequency of exclusive breastfeeding of 43.7% and 53.9% among infants younger than 6 and 4 months of age, respectively. The findings associated with the interruption of exclusive breastfeeding for infants up to 6 months were: higher infant age (P < 0.001), pacifier use (P < 0.001), and lower maternal educational level (P = 0.013).

CONCLUSIONS

In developing countries, specific strategies must be created for the delivery of information about breastfeeding and the effect of pacifier use, especially for less educated women.

Aspectos históricos, científicos, socioeconômicos e institucionais do aleitamento materno

As fontes bibliográficas pesquisadas para esta revisão foram artigos publicados em revistas científicas indexadas, livros, documentos da Organização Mundial da Saúde, Ministério da Saúde e relatórios estaduais e nacionais relacionados à prevalência e medidas de promoção do aleitamento materno. Foi utilizada a base de dados PubMed abrangendo o período de 1952 a 2008. Outros artigos foram identificados em decorrência de citações bibliográficas nas fontes de informações previamente consultadas. Esta pesquisa abrangeu os aspectos históricos relacionados ao aleitamento materno, as evidências científicas de efeitos a curto e longo prazos, fatores associados, modalidades, duração e prevalência do aleitamento materno. Concluiu-se que, apesar da importância amplamente reconhecida dessa prática para mãe, filho, família, comunidade e Estado, e de todas as ações realizadas para promoção, proteção e apoio ao aleitamento materno, os resultados demonstraram que o cumprimento das metas e recomendações internacionais ainda denotam situações insatisfatórias.

A utilização da chupeta e o desenvolvimento sensório motor oral

OBJETIVOS: verificar parâmetros do desenvolvimento sensório motor oral de lactentes no terceiro mês de vida, com e sem o hábito de chupar chupeta, além de identificar a frequência do uso da chupeta entre crianças em aleitamento materno e crianças que iniciaram o desmame. MÉTODOS: estudo observacional com corte transversal, envolvendo 74 bebês que nasceram e estavam realizando acompanhamento no Serviço de Puericultura de uma maternidade da rede pública, Recife-PE. Os dados foram obtidos por meio de entrevista com as mães e observação das crianças. RESULTADOS: as que não utilizavam chupeta apresentaram frequentemente padrão postural global simétrico, melhores respostas aos reflexos orais e língua mais posteriorizada (p=0,034). CONCLUSÃO: constatou-se que as crianças que não utilizaram chupeta apresentaram melhor postura das estruturas orais, como também melhores respostas em relação aos reflexos orais. Nas crianças em aleitamento materno exclusivo foi predominante o não uso da chupeta, havendo associação estatisticamente significante entre o aleitamento materno exclusivo e o não uso da chupeta (p=0,001). Por outro lado, entre as crianças que já haviam iniciado o desmame, o uso da chupeta foi mais frequente.

Pacifier use as a risk factor for reduction in breastfeeding duration: a systematic review

This systematic review of literature proposes to establish whether pacifier use is a risk factor for a reduction in the duration of breastfeeding. A search of the Medline and Lilacs databases was carried out for articles published between 1996 and 2006 using the following descriptors: "breastfeeding" and "pacifier". Articles were excluded if they: had no open access abstracts; did not contain estimators testing the degree of association between breastfeeding duration and pacifier use; involved a follow-up loss of greater than 20%; were written in languages other than Portuguese, English and Spanish; covered specific population categories, such as pre-term babies or mothers who experienced difficulty breastfeeding; or were based on information provided by the mother or a health care professional. Nineteen articles were chosen according to the criteria outlined above; of these, one was a randomized clinical trial, eleven were prospective cohort studies and seven were cross sectional studies. The review concludes that pacifier use is a risk factor for breastfeeding duration, although the performance mechanism remains obscure. Other risk factors relate to the children, their parents and the hospital care they receive regarding the early interruption of breastfeeding. There is a need to standardize the methodology for investigating the association between pacifier use and breastfeeding duration, in order to provide scientific knowledge on this subject.

How to achieve long-term breast-feeding: factors associated with early discontinuation

Objectives

To evaluate the factors associated with discontinuation of breast-feeding before 12 months in order to make suggestions for achieving long-term breast-feeding.

Design

A descriptive cross-sectional study.

Setting

Gazi University Medical School, Ankara, Turkey.

Subjects

Mothers of 1230 children who discontinued breast-feeding at least 15 d before the last visit were asked to fill out a questionnaire about the discontinuation process. Logistic regression analysis was performed to assess the independent effects of factors that might influence breast-feeding discontinuation.

Results

Mean breast-feeding duration of the study group was 11·04 (sd 7·45) months. Introduction of bottle-feeding correlated with discontinuation of breast-feeding (r = 0·507, P = 0·001). Important risk factors for discontinuation of breast-feeding before the first 12 months were not exclusively breast-feeding at 3 and 6 months, prematurity, not having a plan about breast-feeding duration and maternity leave duration of ≤91 d for working mothers. The common reasons for abandoning breast-feeding in the first and second 6 months were similar, namely the mother’s concerns about the sufficiency of breast milk. After 12 months and 18 months the reasons for discontinuation were the baby’s unwillingness to eat solid foods while breast-feeding and the mother’s perception that ‘the baby is old enough’, respectively.

Conclusion

The factors that improve long-term breast-feeding are successful exclusive breast-feeding in the first few months, intention of the mother to breast-feed and sufficient duration of maternity leave. This study emphasizes the importance of successful breast-feeding counselling during the first few months to achieve the desired long-term breast-feeding.

Intake of water, herbal teas and non-breast milks during the first month of life: associated factors and impact on breastfeeding duration

BACKGROUND

The use of non-breast milks seems to cause more harm to the child's health than the isolated introduction of water/herbal teas.

AIMS

Study the factors associated with introduction of water/herbal teas or non-breast milks during the first month of life and determine the impact of this supplementation on breastfeeding duration.

STUDY DESIGN

Nested cross-sectional study.

SUBJECTS

220 mother-infant pairs contacted in the maternity ward, at 7 days and at the end of 1, 2, 4, and 6 months.

OUTCOME MEASURES

Introduction of water/herbal teas or non-breast milks in the first month of life based on data collected during a home visit 30 days after delivery.

RESULTS

Introduction of water/herbal teas was associated with maternal age <20 years (prevalence ratio=1.55; 95%CI 1.14-2.09), <6 prenatal consultations (1.48; 1.09-2.01), cohabitation with maternal grandmother (1.51; 1.10-2.10), and poor latch-on at 30 days (1.87; 1.35-2.58). Introduction of non-breast milks was associated with breastfeeding of previous children for <6 months (3.18; 1.18-8.58), cesarean (1.92; 1.07-3.44), poor latch-on at 30 days (2.82; 1.55-5.11), use of pacifier at 7 days (2.75; 1.38-5.48), introduction of herbal teas in the first 7 days (2.75; 1.15-4.15) and breast engorgement at 7 days (2.19; 1.01-3.16). Introduction of non-breast milks negatively influenced breastfeeding duration (p<0.001); this was not observed with water/herbal teas (p=0.277).

CONCLUSION

Priority should be given to preventing the early introduction on non-breast milks, especially in mother-infant pairs with associated risk factors.