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Abstract
Applied behavior analysis has the most empirical support as intervention for pediatric feeding disorders, when a child does not eat or drink a sufficient quantity or variety of food to maintain proper nutrition. Interdisciplinary collaboration is crucial for diagnosis, referral, and management of pediatric feeding disorders because the etiology is complex and multifactorial. Thus, our aim is to provide information about how to recognize a feeding disorder, to delineate the environmental variables implicated in the etiology and maintenance of feeding disorders, and to provide recommendations for prevention and intervention for feeding disorders based on the applied-behavior analytic literature.
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Affiliation(s)
- Vivian F Ibañez
- Children's Specialized Hospital and Rutgers University, 200 Somerset St, New Brunswick, NJ 08901, USA.
| | - Kathryn M Peterson
- Children's Specialized Hospital and Rutgers University, 200 Somerset St, New Brunswick, NJ 08901, USA
| | | | - Sarah D Haney
- University of Nebraska Medical Center's Munroe-Meyer Institute, 42nd and Emile, Omaha, NE 68198, USA
| | - Ashley S Andersen
- University of Nebraska Medical Center's Munroe-Meyer Institute, 42nd and Emile, Omaha, NE 68198, USA
| | - Cathleen C Piazza
- Rutgers University Graduate School of Applied and Professional Psychology and Children's Specialized Hospital, 152 Frelinghuysen Road, Piscataway, NJ 08854, USA
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2
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Zarshenas M, Zhao Y, Scott JA, Binns CW. Determinants of Breastfeeding Duration in Shiraz, Southwest Iran. Int J Environ Res Public Health 2020; 17:ijerph17041192. [PMID: 32069861 PMCID: PMC7068444 DOI: 10.3390/ijerph17041192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/06/2020] [Accepted: 02/08/2020] [Indexed: 12/23/2022]
Abstract
A prospective cohort study was conducted in Shiraz in the south west of Iran to investigate breastfeeding from birth to six months of age. Mothers were recruited in a face-to-face interview within 48 h of giving birth in three public and two private hospitals (n = 700). They were then followed-up at 4, 12, 16, and 26 weeks postpartum in local Maternal and Child Health Clinics. Upon being discharge from hospital, 98.7% of mothers were breastfeeding and 74.3% were 'fully' breastfeeding, but only 29.9% of mothers had breastfed 'exclusively' since birth. The median duration of 'full' breastfeeding was 13 weeks and less than 1 week for exclusive breastfeeding. In a multivariable Cox proportional hazard regression, after adjustment, shorter durations of 'exclusive', 'full', and 'any' breastfeeding were associated with the introduction of a pacifier. The in-hospital use of formula and prelacteal feeds were also associated with a shorter duration of full and any breastfeeding. Breastfeeding on demand at 3 months and beyond was associated with a longer duration of breastfeeding. The risk factors associated with the premature discontinuation of breastfeeding identified in this study are all related to the "Ten steps to successful breastfeeding" and the Baby Friendly Hospital Initiative (BFHI). The principles that the BFHI provide are reaffirmed in this study as the basis for future breastfeeding promotion programs.
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Affiliation(s)
- Mahnaz Zarshenas
- Fatemeh College of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran
- Correspondence: (M.Z.); (C.W.B.)
| | - Yun Zhao
- School of Public Health, Curtin University, Perth 6845, Australia; (Y.Z.); (J.A.S.)
| | - Jane A. Scott
- School of Public Health, Curtin University, Perth 6845, Australia; (Y.Z.); (J.A.S.)
| | - Colin W. Binns
- School of Public Health, Curtin University, Perth 6845, Australia; (Y.Z.); (J.A.S.)
- Correspondence: (M.Z.); (C.W.B.)
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Habibi M, Laamiri FZ, Aguenaou H, Doukkali L, Mrabet M, Barkat A. The impact of maternal socio-demographic characteristics on breastfeeding knowledge and practices: An experience from Casablanca, Morocco. Int J Pediatr Adolesc Med 2018; 5:39-48. [PMID: 30805532 PMCID: PMC6363246 DOI: 10.1016/j.ijpam.2018.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/24/2017] [Accepted: 01/18/2018] [Indexed: 12/21/2022]
Abstract
Background Breastfeeding is universally recognized by the World Health Organization as the best way of feeding infants. Therefore, several countries have initiated health promotion interventions to support successful breastfeeding based on the factors influencing breastfeeding outcomes. Objective To examine the association between the knowledge of breastfeeding and maternal socioeconomic and demographic characteristics, and to determine any impact on child nutritional status. Methods A cross-sectional study using both qualitative and quantitative methods was conducted with mothers of infants aged six- to twenty-four months. Data was collected by a semi-structured questionnaire and face-to-face, in-depth interviews with mothers to get an insight into their breastfeeding perceptions and experiences. Educational achievement and occupational class were used as indicators of socio-demographic status. Nutritional status was assessed by anthropometric measurements. Results A significant relationship between exclusive breastfeeding and the mother's education (P < .001) and socio-economic status (P < .001) has been highlighted. A significant link was pointed out between breastfeeding and length-for-age Z score (LAZ) (P < .001), and weight-for-age Z score (WAZ) (P = .005). Moreover, a strong association was found between maternal employment and exclusive breastfeeding (P < .001). Conclusions Our findings shed some light on challenges faced by mothers, as well as an association between socio-demographic characteristics and practices for facilitating exclusive breastfeeding to guide the mothers in breastfeeding management.
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Affiliation(s)
- Mouna Habibi
- Research Team on Health and Nutrition of Mother and Child, University Mohammed V, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Fatima Zahra Laamiri
- Research Team on Health and Nutrition of Mother and Child, University Mohammed V, Faculty of Medicine and Pharmacy, Rabat, Morocco.,Higher Institute of Nursing Professions and Technical Health, Rabat, Morocco
| | - Hassan Aguenaou
- Joint Unit for Nutrition and Food Research at Ibn Tofaïl University (URAC 39), National Centre for Nuclear Energy, Sciences and Technology (CNESTEN), RDC-Nutrition AFRA/AIEA, Morocco
| | - Loubna Doukkali
- Research Team on Health and Nutrition of Mother and Child, University Mohammed V, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Mustapha Mrabet
- Research Team on Health and Nutrition of Mother and Child, University Mohammed V, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Amina Barkat
- Research Team on Health and Nutrition of Mother and Child, University Mohammed V, Faculty of Medicine and Pharmacy, Rabat, Morocco.,National Reference Center for Neonatology and Nutrition, Children's Hospital, Ibn Sina University Hospital Centre, Rabat, Morocco
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Abstract
Few studies to date have investigated the relationship between pacifier use or finger sucking and infant sleep. One hundred and four mothers of infants (ages 0-11 months) completed the Brief Infant Sleep Questionnaire (BISQ). Infants who engaged in finger sucking had fewer night wakings and longer stretches of nighttime sleep, although less daytime sleep. There were no significant differences in sleep patterns between pacifier users and infants who did not engage in nonnutritive sucking. Furthermore, no significant differences were found across groups for sleep ecology, including parental involvement at bedtime and following night wakings. Finally, infants were consistently able to retrieve their pacifiers independently by 7 months of age, although this did not appear to be associated with sleep outcomes. Results suggest that when parents are deciding whether to give their infant a pacifier, sleep may not be a critical factor. In contrast, parents of finger and thumb suckers should be reassured that this nonnutritive sucking is beneficial to sleep, at least in the first year of life.
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Affiliation(s)
- Rachel Butler
- a Saint Joseph's University , Philadelphia , Pennsylvania
| | - Melisa Moore
- b Children's Hospital of Philadelphia , Pennsylvania
| | - Jodi A Mindell
- a Saint Joseph's University , Philadelphia , Pennsylvania.,b Children's Hospital of Philadelphia , Pennsylvania
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5
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Abstract
BACKGROUND Non-nutritive sucking (NNS) is used during gavage feeding and in the transition from gavage to breast/bottle feeding in preterm infants to improve the development of sucking behavior and the digestion of enteral feedings. OBJECTIVES To assess the effects of non-nutritive sucking on physiologic stability and nutrition in preterm infants. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 1), MEDLINE via PubMed (1966 to 25 February 2016), Embase (1980 to 25 February 2016), and CINAHL (1982 to 25 February 2016). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials. SELECTION CRITERIA Randomised controlled trials and quasi-randomised trials that compared non-nutritive sucking versus no provision of non-nutritive sucking in preterm infants. We excluded cross-over trials. DATA COLLECTION AND ANALYSIS Two review authors assessed trial eligibility and risk of bias and undertook data extraction independently. We analysed the treatment effects in the individual trials and reported mean differences (MD) for continuous data, with 95% confidence intervals (CIs). We used a fixed-effect model in meta-analyses. We did not perform subgroup analyses because of the small number of studies related to the relevant outcomes. We used the GRADE approach to assess the quality of evidence. MAIN RESULTS We identified 12 eligible trials enrolling a total of 746 preterm infants. Meta-analysis, though limited by data quality, demonstrated a significant effect of NNS on transition from gavage to full oral feeding (MD -5.51 days, 95% CI -8.20 to -2.82; N = 87), transition from start of oral feeding to full oral feeding (MD -2.15 days, 95% CI -3.12 to -1.17; N = 100), and the length of hospital stay (MD -4.59 days, 95% CI -8.07 to -1.11; N = 501). Meta-analysis revealed no significant effect of NNS on weight gain. One study found that the NNS group had a significantly shorter intestinal transit time during gavage feeding compared to the control group (MD -10.50 h, 95% CI -13.74 to -7.26; N = 30). Other individual studies demonstrated no clear positive effect of NNS on age of infant at full oral feeds, days from birth to full breastfeeding, rates and proportion of infants fully breastfeeding at discharge, episodes of bradycardia, or episodes of oxygen desaturation. None of the studies reported any negative outcomes. These trials were generally small and contained various methodological weaknesses including lack of blinding of intervention and outcome assessors and variability on outcome measures. The quality of the evidence on outcomes assessed according to GRADE was low to very low. AUTHORS' CONCLUSIONS Meta-analysis demonstrated a significant effect of NNS on the transition from gavage to full oral feeding, transition from start of oral feeding to full oral feeding, and length of hospital stay. None of the trials reported any adverse effects. Well-designed, adequately powered studies using reliable methods of randomisation, concealment of treatment allocation and blinding of the intervention and outcome assessors are needed. In order to facilitate meta-analysis of these data, future research should involve outcome measures consistent with those used in previous studies.
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Affiliation(s)
- Jann P Foster
- Western Sydney UniversitySchool of Nursing and MidwiferyPenrith DCAustralia
- University of SydneyCentral Clinical School, Discipline of Obstetrics, Gynaecology and NeonatologyCamperdownAustralia
- Ingham Research InstituteLiverpoolNSWAustralia
| | - Kim Psaila
- Western Sydney UniversitySchool of Nursing and MidwiferyPenrithDCAustralia
| | - Tiffany Patterson
- Western Sydney UniversitySchool of Nursing and MidwiferySydneyAustralia
- Ingham Institute for Applied Medical ResearchLiverpoolNSWAustralia
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6
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Abstract
BACKGROUND To successfully initiate and maintain breastfeeding for a longer duration, the World Health Organization's Ten Steps to Successful Breastfeeding recommends total avoidance of artificial teats or pacifiers for breastfeeding infants. Concerns have been raised that offering the pacifier instead of the breast to calm the infant may lead to less frequent episodes of breastfeeding and as a consequence may reduce breast-milk production and shorten duration of breastfeeding. OBJECTIVES To assess the effect of restricted versus unrestricted pacifier use in healthy full-term newborns whose mothers have initiated breastfeeding and intend to exclusively breastfeed, on the duration of breastfeeding, other breastfeeding outcomes and infant health. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2016) and reference lists of retrieved studies. SELECTION CRITERIA Randomised and quasi-randomised controlled trials comparing restricted versus unrestricted pacifier use in healthy full-term newborns who have initiated breastfeeding. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS We found three trials (involving 1915 babies) for inclusion in the review, but have included only two trials (involving 1302 healthy full-term breastfeeding infants) in the analysis. Meta-analysis of the two combined studies showed that pacifier use in healthy breastfeeding infants had no significant effect on the proportion of infants exclusively breastfed at three months (risk ratio (RR) 1.01; 95% confidence interval (CI) 0.96 to 1.07, two studies, 1228 infants), and at four months of age (RR 1.01; 95% CI 0.94 to 1.09, one study, 970 infants, moderate-quality evidence), and also had no effect on the proportion of infants partially breastfed at three months (RR 1.00; 95% CI 0.98 to 1.02, two studies, 1228 infants), and at four months of age (RR 0.99; 95% CI 0.97 to 1.02, one study, 970 infants). None of the included trials reported data on the other primary outcomes, i.e. duration of partial or exclusive breastfeeding, or secondary outcomes: breastfeeding difficulties (mastitis, cracked nipples, breast engorgement); infant's health (dental malocclusion, otitis media, oral candidiasis; sudden infant death syndrome (SIDS)); maternal satisfaction and level of confidence in parenting. One study reported that avoidance of pacifiers had no effect on cry/fuss behavior at ages four, six, or nine weeks and also reported no effect on the risk of weaning before age three months, however the data were incomplete and so could not be included for analysis. AUTHORS' CONCLUSIONS Pacifier use in healthy term breastfeeding infants, started from birth or after lactation is established, did not significantly affect the prevalence or duration of exclusive and partial breastfeeding up to four months of age. Evidence to assess the short-term breastfeeding difficulties faced by mothers and long-term effect of pacifiers on infants' health is lacking.
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Affiliation(s)
- Sharifah Halimah Jaafar
- Regency Specialist HospitalDepartment of Obstetrics and GynaecologyNo 1 Jalan Suria,Bandar Seri AlamJohor BahruJohorMalaysia81750
| | - Jacqueline J Ho
- Penang Medical CollegeDepartment of Paediatrics4 Sepoy LinesPenangMalaysia10450
| | - Shayesteh Jahanfar
- University of British ColumbiaDepartment of Public Health, School of Population and Public Health2206 East MallVancouverBCCanadaVT6 1Z3
| | - Mubashir Angolkar
- JN Medical CollegeWomen's and Children's Health ResearchNehru NagarBelgaumKarnatakaIndia590010
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Abstract
To investigate African-American parental reasons for pacifier use or non-use, and whether knowledge of the association with decreased SIDS risk changes decisions about pacifier use. We conducted focus groups and individual interviews with mothers. Grounded theory methodology was used. 83 mothers participated; 72.3 % of infants used pacifiers. Reasons for pacifier use included comfort/soothing, safety/SIDS, and preference over digit-sucking. Reasons for pacifier non-use included infant refusal, fear of attachment, nipple confusion, and germs. Many parents were unaware that pacifier use reduces SIDS risk; however, most parents of non-users did not think that this knowledge would have changed their decision. Reasons included skepticism about the pacifier-SIDS link. Many reasons underlie African-American parental decisions about pacifier use. Providers should provide information about the benefits of pacifiers. Establishing for parents any plausible link between the protective mechanism of pacifiers and SIDS pathophysiology may be important in promoting pacifier use.
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Affiliation(s)
- Brandi L Joyner
- Goldberg Center for Community Pediatric Health, Children's National Medical Center, Washington, DC, USA
| | - Rosalind P Oden
- Goldberg Center for Community Pediatric Health, Children's National Medical Center, Washington, DC, USA
| | - Rachel Y Moon
- Goldberg Center for Community Pediatric Health, Children's National Medical Center, Washington, DC, USA.
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- Division of General Pediatrics and Community Health, Children's National Medical Center, 111 Michigan Avenue, NW, Washington, DC, 20010, USA.
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Pérez-Escamilla R, Martinez JL, Segura-Pérez S. Impact of the Baby-friendly Hospital Initiative on breastfeeding and child health outcomes: a systematic review. Matern Child Nutr 2016; 12:402-17. [PMID: 26924775 DOI: 10.1111/mcn.12294] [Citation(s) in RCA: 300] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 12/21/2015] [Accepted: 12/31/2015] [Indexed: 12/12/2022]
Abstract
The Baby-friendly Hospital Initiative (BFHI) is a key component of the World Health Organization/United Nations Children's Fund Global Strategy for Infant and Young Child Feeding. The primary aim of this narrative systematic review was to examine the impact of BFHI implementation on breastfeeding and child health outcomes worldwide and in the United States. Experimental, quasi-experimental and observational studies were considered eligible for this review if they assessed breastfeeding outcomes and/or infant health outcomes for healthy, term infants born in a hospital or birthing center with full or partial implementation of BFHI steps. Of the 58 reports included in the systematic review, nine of them were published based on three randomized controlled trials, 19 followed quasi-experimental designs, 11 were prospective and 19 were cross-sectional or retrospective. Studies were conducted in 19 different countries located in South America, North America, Western Europe, Eastern Europe, South Asia, Eurasia and Sub-Saharan Africa. Adherence to the BFHI Ten Steps has a positive impact on short-term, medium-term and long-term breastfeeding (BF) outcomes. There is a dose-response relationship between the number of BFHI steps women are exposed to and the likelihood of improved BF outcomes (early BF initiation, exclusive breastfeeding (EBF) at hospital discharge, any BF and EBF duration). Community support (step 10) appears to be essential for sustaining breastfeeding impacts of BFHI in the longer term.
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Affiliation(s)
- Rafael Pérez-Escamilla
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Josefa L Martinez
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
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Horne RSC, Fyfe KL, Odoi A, Athukoralage A, Yiallourou SR, Wong FY. Dummy/pacifier use in preterm infants increases blood pressure and improves heart rate control. Pediatr Res 2016; 79:325-32. [PMID: 26488553 DOI: 10.1038/pr.2015.212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 08/04/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Preterm infants are at increased risk of sudden infant death syndrome (SIDS). Use of a dummy/pacifier is thought to be protective against SIDS; accordingly, we assessed the effects of dummy/pacifier use on blood pressure, cerebral oxygenation, and heart rate control over the first 6 mo of life after term corrected age (CA) when SIDS risk is greatest. METHODS Thirty-five preterm infants were studied longitudinally at 2-4 wk, 2-3 mo, and 5-6 mo CA. Cardiac control was assessed from spectral indices of heart rate variability (HRV) in the low frequency (LF) and the high frequency (HF) range, and the ratio of HF/LF indicating sympathovagal balance was calculated. RESULTS Overall, at 2-3 mo, mean arterial pressure was significantly higher in the supine position in dummy/pacifier users in both quiet sleep (70 ± 2 vs. 60 ± 2 mm Hg; P < 0.05) and active sleep (74 ± 3 vs. 69 ± 2 mm Hg; P < 0.05). Dummy/pacifier users had higher LF HRV and LF/HF ratio and lower HF HRV. CONCLUSION Dummy/pacifier use increased blood pressure during sleep, at the age of greatest SIDS risk. Overall, LF HRV was elevated and HF HRV reduced in dummy/pacifier users, suggesting that dummy use alters cardiac control in preterm infants.
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Affiliation(s)
- Rosemary S C Horne
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - Karinna L Fyfe
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - Alexsandria Odoi
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia
| | - Anjalee Athukoralage
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia
| | - Stephanie R Yiallourou
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - Flora Y Wong
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia.,Monash Newborn, Monash Medical Centre, Melbourne, Australia
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10
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Alm B, Wennergren G, Möllborg P, Lagercrantz H. Breastfeeding and dummy use have a protective effect on sudden infant death syndrome. Acta Paediatr 2016; 105:31-8. [PMID: 26175065 PMCID: PMC5049485 DOI: 10.1111/apa.13124] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/17/2015] [Accepted: 07/07/2015] [Indexed: 12/26/2022]
Abstract
We conducted a literature review on the effect of breastfeeding and dummy (pacifier) use on sudden infant death syndrome (SIDS). From 4343 abstracts, we identified 35 relevant studies on breastfeeding and SIDS, 27 on dummy use and SIDS and 59 on dummy use versus breastfeeding. Conclusion We found ample evidence that both breastfeeding and dummy use reduce the risk of SIDS. There has been a general reluctance to endorse dummy use in case it has a detrimental effect of breastfeeding. However, recent evidence suggests that dummy use might not be as harmful to breastfeeding as previously believed.
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Affiliation(s)
- Bernt Alm
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
| | - Göran Wennergren
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
| | - Per Möllborg
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
| | - Hugo Lagercrantz
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
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Horne RSC, Hauck FR, Moon RY, L'hoir MP, Blair PS. Dummy (pacifier) use and sudden infant death syndrome: potential advantages and disadvantages. J Paediatr Child Health 2014; 50:170-4. [PMID: 24674245 DOI: 10.1111/jpc.12402] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2013] [Indexed: 12/01/2022]
Abstract
The large decline in deaths due to the sudden infant death syndrome (SIDS) in the last 20 years in many countries is largely due to risk-reduction advice resulting from observational studies that examined the relationship between infant care practices and SIDS. Most of this advice remains largely uncontroversial and educators and researchers in this field are in agreement as to the specific recommendations that should be given to parents and health professionals. However, advice surrounding the apparent protective effect of dummies (also known as pacifiers) has been controversial. Several systematic reviews have demonstrated a strong association between the lack of a pacifier being used by the infant for the final sleep and SIDS, but it is not clear how pacifiers confer protection or if this is a marker for something as yet unmeasured. The Epidemiology and Physiology Working Groups of the International Society for the Study and Prevention of Perinatal and Infant Death (ISPID) are comprised of leading SIDS researchers with an objective to provide evidence-based position statements surrounding the factors associated with SIDS (http://www.ispid.org/) and risk-reduction strategies. The evidence, discussion and conclusions from these working groups regarding dummies (pacifiers) are described below to help inform this debate and describe the future evidence required so that we might find a common recommendation about dummies (pacifiers) and SIDS.
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Affiliation(s)
- Rosemary S C Horne
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Australia
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12
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Assathiany R. Le pédiatre et la sucette : tétine et tais-toi. Arch Pediatr 2013. [DOI: 10.1016/s0929-693x(13)71295-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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13
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Abstract
BACKGROUND To successfully initiate and maintain breastfeeding for a longer duration, the World Health Organization's Ten Steps to Successful Breastfeeding recommends total avoidance of artificial teats or pacifiers for breastfeeding infants. Offering the pacifier instead of the breast to calm the infant may lead to less frequent episodes of breastfeeding and as a consequence may reduce breast milk production and shorten duration of breastfeeding; however, this remains unclear. OBJECTIVES To assess the effect of unrestricted versus restricted pacifier use in healthy full-term newborns whose mothers have initiated breastfeeding and intend to exclusively breastfeed, on the duration of breastfeeding, other breastfeeding outcomes and infant health. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (14 March 2012). SELECTION CRITERIA Randomised and quasi-randomised controlled trials comparing unrestricted versus restricted pacifier use in healthy full-term newborns who have initiated breastfeeding regardless of whether they were born at home or in the hospital. DATA COLLECTION AND ANALYSIS Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. Data were checked for accuracy. MAIN RESULTS We found three trials (involving 1915 babies) for inclusion in the review but have included only two trials (involving 1302 healthy full-term breastfeeding infants) in the analysis. Meta-analysis of the two combined studies showed that pacifier use in healthy breastfeeding infants had no significant effect on the proportion of infants exclusively breastfed at three months (risk ratio (RR) 0.99; 95% confidence interval (CI) 0.93 to 1.05), and at four months of age (RR 0.99; 95% CI 0.92 to 1.06) and also had no effect on the proportion of infants partially breastfed at three months (RR 1.00; 95% CI 0.98 to 1.13), and at 4 months of age (RR 1.01; 95% CI 0.98 to 1.03). AUTHORS' CONCLUSIONS Pacifier use in healthy term breastfeeding infants, started from birth or after lactation is established, did not significantly affect the prevalence or duration of exclusive and partial breastfeeding up to four months of age. However, evidence to assess the short-term breastfeeding difficulties faced by mothers and long-term effect of pacifiers on infants' health is lacking.
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