Association between breastfeeding and breathing pattern in children: a sectional study

Impact of Breastfeeding Duration on Adenoid Hypertrophy, Snoring and Acute Otitis Media: A Case-Control Study in Preschool Children

BACKGROUND

The aim of this study was to analyze the relationship between breastfeeding duration and adenoid size, snoring and acute otitis media (AOM).

METHODS

We analyzed the medical history of children admitted to the ENT outpatient clinic in 2022 and 2023, reported symptoms, ear, nose and throat (ENT) examination, and flexible nasopharyngoscopy examination of 145 children aged 3-5 years.

RESULTS

Breastfeeding duration of 3 and 6 months or more had a significant effect on the reduction of snoring (p = 0.021; p = 0.039). However, it had no effect on the adenoid size, mucus coverage and sleeping with an open mouth. Snoring was correlated with open mouth sleeping (p < 0.001), adenoid size with a 75% A/C ratio or more (p < 0.001), and adenoid mucus coverage in the Mucus of Adenoid Scale by Nasopharyngoscopy Assessment-MASNA scale (p = 0.009). Children who were breastfed for less than 3 months had more than a four-fold greater risk of snoring. There was a statistically significant correlation between AOM and gender (p = 0.033), breastfeeding duration in groups fed 1, 3 or 6 months or more (p = 0.018; p = 0.004; p = 0.004) and those fed with mother's breast milk 3 or 6 months or more (p = 0.009; p = 0.010). Moreover, a correlation was found between adenoid size and mucus coverage, tympanogram, and open-mouth sleeping (p < 0.001). Independent factors of snoring in 3- to 5-year-old children were breastfeeding duration of less than 3 months (p = 0.032), adenoid size with an A/C ratio of 75% or more (p = 0.023) and open mouth sleeping (p = 0.001).

CONCLUSIONS

Children breastfed for 3 and 6 months or more exhibited reduced rates of snoring. There was no effect of breastfeeding duration on adenoid size in children aged 3 to 5 years, suggesting that the link between breastfeeding duration and snoring is primarily associated with craniofacial development and muscle tone stimulation. A breastfeeding duration of 1 month or more plays a key role in reducing the rate of AOM. The mother's milk plays a protective role against AOM. The presence of mucus might be responsible for snoring in preschool children. A medical history of breastfeeding should be taken into consideration when snoring children are suspected of adenoid hypertrophy.

Integration of Breastfeeding Consultation and Practices in the Scope of Pediatric Dentistry: Collaboration with Lactation Specialists

Background

In recent years, breastfeeding has been largely promoted due to health benefits for the children and the mothers and social, economic, and environmental advantages. World Health Organization (WHO) recommends breastfeeding for at least 2 years and to be continued for as long as this is desired by the mother-child dyad.Despite its advantages, including protection against caries in the 1st year of life, prevention of malocclusions, and development of more normal breathing patterns, there is a great controversy in the literature regarding breastfeeding involvement in elevated risk for early childhood caries (ECC).Breastfeeding and oral health are strongly related. Breastfeeding can influence oral health and development, but oral findings, such as tethered tissues and natal/neonatal teeth, may negatively affect lactation.

Conclusion

A healthy collaboration between the oral health care provider and the lactation specialist is important in order to identify those oral findings and prevent breastfeeding implications, but also in order to facilitate uneventful breastfeeding by emphasizing oral health care prevention strategies.

Clinical significance

Information on the advantages of certain lactation aspects and the potential risks for ECC is important for the pediatric dentist to be able to form an individualized treatment/prevention plan that will benefit and promote the oral and general health of young patients.

How to cite this article

Papadopoulou P, Boka V, Arapostathis K. Integration of Breastfeeding Consultation and Practices in the Scope of Pediatric Dentistry: Collaboration with Lactation Specialists. Int J Clin Pediatr Dent 2023;16(S-3):S306-S310.

Correlation of facial anthropometry data of late preterm newborns and oral feeding readiness

OBJECTIVE

To correlate nine facial anthropometric measurements with the readiness for oral feeding of late preterm newborns using an orogastric tube.

METHODS

Observational study, carried out in two institutions in Maceió, Alagoas. Fifty-two newborns participated. A single measuring of nine facial measurements and daily measuring of the interface area for fixing the tube was performed. For readiness assessment, the Premature Oral Feeding Readiness Assessment Scale was used.

RESULTS

An average readiness of 28.81 (± 3.18) was observed in the first evaluation and 30.65 (± 3.23) in the second. Most facial measurements are correlated with weight. There was a positive and slight correlation between glabella-subnasale distance and readiness. No correlation was observed between the area of the tube fixation interface and facial measurements.

CONCLUSION

It is concluded that the glabella-subnasale measurement is positively correlated with the readiness for oral feeding in late preterm newborns who used an orogastric tube for feeding.

Do breastfed children have a lower chance of developing mouth breathing? A systematic review and meta-analysis

OBJECTIVE

Determine the association between breastfeeding and the development of mouth breathing in children.

MATERIALS AND METHODS

Seven databases were searched for studies investigating the association between the type of feeding and the development of the breathing pattern in children. Descriptive analysis and meta-analysis were performed, with the calculation of the prevalence and likelihood (odds ratios (95% CI)) of mouth breathing according to the duration of breastfeeding.

RESULTS

The overall prevalence of mouth breathing was 44% (95% CI: 38-49) (N total = 1182). Breastfeeding was a protection factor against the development of mouth breathing (OR = 0.62; 95% CI: 0.41-0.93). The likelihood of developing mouth breathing was 41% and 34% lower among children that were breastfed for more than 12 and more than 24 months, respectively. No association was found between exclusive breastfeeding for up to 6 months and the occurrence of mouth breathing (OR = 0.60; 95% CI: 0.31-1.18).

CONCLUSIONS

Due to the scarcity of cohort studies that met the inclusion criteria and the low certainty of the evidence, no strong evidence-based conclusion can be drawn. However, breastfeeding should be encouraged due to its possible protective effect, evidenced by the substantial reduction in the prevalence of mouth breathing pattern when performed for up to 2 years. Exclusive breastfeeding was not associated with the development of the breathing pattern.

CLINICAL RELEVANCE

The results reveal that breastfeeding can protect children from the development of mouth breathing. Thus, healthcare providers should offer support so that mothers feel prepared and encouraged to perform breastfeeding.

TRIAL REGISTRATION

PROSPERO registry: CRD42017062172.

Motivos associados à interrupção do aleitamento materno exclusivo até seis meses de idade em lactentes acompanhados em Estratégias de Saúde da Família da cidade de Registro, São Paulo

Objetivo: Identificar os motivos associados à interrupção do aleitamento materno exclusivo entre nutrizes durante os primeiros seis meses de vida do lactente. Métodos: Estudo exploratório, descritivo, transversal, com abordagem quantitativa, conduzido com 911 mães/responsáveis de crianças de zero a 23 meses. Foram coletadas informações sociodemográficas e relato dos motivos que levaram a interrupção do aleitamento materno exclusivo antes dos seis meses de idade do lactente. Resultados: As participantes do estudo eram predominantemente brancas, com companheiro, com ensino médio, sem vínculo empregatício, com dois a quatro filhos, com renda familiar ≤ 1 salário mínimo, com moradia própria, na faixa etária ≥ 20 anos. Em sua maioria, as mães/responsáveis relataram ter recebido orientações sobre a alimentação de seu filho com maior frequência realizada pelo enfermeiro e 28,5% afirmaram ter interrompido o aleitamento materno exclusivo antes dos seis meses de vida do lactente. Possuir moradia própria, usar de tabaco e álcool foram associados à interrupção do aleitamento materno exclusivo. Os motivos que predominaram na interrupção do aleitamento materno exclusivo estiveram ligados principalmente ao relato de leite materno insuficiente, retorno ao trabalho/escola e recusa inexplicada. Conclusão: Os motivos para abandono do aleitamento materno exclusivo identificado neste estudo foram desde o relato de choro da criança à alegação de leite materno insuficiente. A identificação dos motivos que levam ao desmame precoce pode auxiliar no planejamento de estratégias para evitar a interrupção do aleitamento materno.

Growth and mouth breathers

OBJECTIVE

To assess the relationship between mouth breathing and growth disorders among children and teenagers.

DATA SOURCE

Search on MEDLINE database, over the last 10 years, by using the following terms: "mouth breathing", "adenotonsilar hypertrophy", "allergic rhinitis", "sleep disturbance" AND "growth impairment", "growth hormone", "failure to thrive", "short stature", or "failure to thrive".

DATA SUMMARY

A total of 247 articles were identified and, after reading the headings, this number was reduced to 45 articles, whose abstracts were read and, of these, 20 were deemed important and were included in the review. In addition of these articles, references mentioned in them and specific books on mouth breathing deemed important were included. Hypertrophy of palatine and/or pharyngeal tonsils, whether associated with allergic rhinitis, as well as poorly controlled allergic rhinitis, are the main causes of mouth breathing in children. Respiratory sleep disorders are frequent among these patients. Several studies associate mouth breathing with reduced growth, as well as with reduced growth hormone release, which are reestablished after effective treatment of mouth breathing (clinical and/or surgical).

CONCLUSIONS

Mouth breathing should be considered as a potential cause of growth retardation in children; pediatricians should assess these patients in a broad manner.

Avaliação do aleitamento materno em crianças até dois anos assistidas na atenção básica do Recife, Pernambuco, Brasil

Resumo O presente estudo teve por objetivo avaliar o aleitamento materno exclusivo (AME) e total em crianças até 2 anos de idade atendidas em Unidades Básicas de Saúde (UBS) do Recife-PE. Estudo descritivo transversal, realizado nas Unidades Básicas de Saúde da Mustardinha, Jardim Uchôa, Fernandes Figueira e Upinha Novo Prado. A população foi composta por crianças de 0 a 24 meses de idade. Foram avaliadas 141 crianças, das quais 54,6% eram do sexo feminino, 22% tinham idade ≤ 6 meses, 21,3% entre 7 a 12 meses e 56,7% entre 13 e 24 meses. Ao analisar a prevalência de aleitamento materno exclusivo e total, verificou-se a mediana de 60,84 e 182,52 dias, respectivamente. Crianças do sexo masculino, uso de chupeta e mamadeira foram associados ao menor tempo de aleitamento materno exclusivo.

Association Between Breastfeeding and Childhood Breathing Patterns: A Systematic Review and Meta-Analysis

OBJECTIVES

This systematic review aimed to evaluate the association between breastfeeding and breathing patterns in children.

MATERIALS AND METHODS

We searched PubMed, EMBASE, Web of Science, CINAHL, and the Cochrane Central Register of Controlled Trials for publications from inception to October 1, 2017. The breastfeeding duration and period of exclusive breastfeeding were selected as primary outcomes. The odds ratio (OR) and 95% confidence interval (CI) were calculated. A meta-analysis was conducted to synthesize the evidence. The Newcastle-Ottawa Score was used for quality and comparability assessment.

RESULTS

Of the 54 articles identified, three observational studies met the inclusion criteria for this meta-analysis, representing 1,046 participants. The results of the meta-analysis revealed that the prevalence rate of mouth breathing (OR = 2.04; 95% CI, 1.26-3.31; p = 0.004) was significantly higher in subjects who were breastfed for less than 6 months, but no significant difference was observed within the periods of exclusive breastfeeding (6 months or less) (OR = 1.27; 95% CI, 0.73-2.21; p = 0.40).

CONCLUSION

We found only limited evidence about the association between breastfeeding and breathing patterns. However, the current evidence supports the association between breastfeeding and childhood breathing patterns. Based on this review, we found that the frequency of normal nasal respiration increases with the duration of breastfeeding. The methodological quality of the studies included was moderate. Thus, future studies should aim to correct the confounding factors related to breathing patterns, to use standardized diagnostic criteria of mouth breathing, and to conduct a prospective research to reduce the recall bias.

The impact of oronasal breathing on perioral musculature

ABSTRACT Purpose: to compare the behavior of perioral muscles in nasal, oral and oronasal respirators. Methods: a sample consisting of three distinct groups, equally subdivided into Nasal, Oral and Oronasal Respirators. The behavior of the orbicular muscle of the mouth (upper part) and mentual one was measured by surface electromyography at rest, swallowing and labial isometry. Results: in all situations investigated, the orbicular muscle of the mouth (upper part) and mental muscle showed no significant difference in relation to Root Means Square, that is, average electrical activity between Oral and Oronasal Respirators. The data showed a significant difference in In Nasal Respirators, as compared to the other groups. Conclusion: similarity was seen in the comparison of perioral muscles behavior between oral and oronasal respirators, however, a significant difference in relation to nasal respirators.

Association between harmful oral habits and the structures and functions of the stomatognathic system: perception of parents/guardians

Purpose

To verify the occurrence and associate the presence and duration of harmful oral habits with the structures and functions of the stomatognathic system.

Methods

This is a cross-sectional, exploratory study. Participants' participation was formalized by the signing of an Informed Consent Form. The non-probabilistic sample comprised 289 children aged one to 12 years assisted at a Family Health Strategy unit. The data were obtained through a questionnaire to identify harmful oral habits applied to the children's parents and/or guardians. The results were considered at 5% level of significance. The statistical analyses were performed using the SPSS 19.0 software and the chi-squared association test was employed to investigate the categorical variables.

Results

The breastfeeding rate found was 85%; however, only 32.4% of the children were exclusively breastfed until six months of age. The most prevalent habits and those currently maintained were use of conventional bottle (28.62%) and conventional pacifier (23.18%). Significant correlation (p=0.001) was found between keeping the mouth open and oral and oronasal breathing. The presence of habits such as using orthodontic bottle (p=0.016) and orthodontic pacifier (p=0.001) was associated with the breathing mode reported. Habit duration was associated with the perception of changes in speech (p=0.046) and with malocclusion (p=0.014).

Conclusion

The presence and duration of harmful oral habits were associated with the perception of changes in the structures and functions of the stomatognathic system regarding occlusion, breathing, and speech, accounting for a significant portion of the demand for rehabilitation.

Development of a questionnaire for measuring health-related quality of life among children and adolescents with mouth breathing

BACKGROUND

Mouth breathing can exert an influence on quality of life and should be evaluated within a multidimensional context. However, there is no specific questionnaire to measure the impact of mouth breathing on quality of life.

OBJECTIVE

To develop and validate a questionnaire for measuring the impact of mouth breathing on quality of life among children and adolescents.

METHODS

Thirty-six items were evaluated by six health care professionals, one parent and one child with mouth breathing. After a qualitative evaluation, a modified set of 32 items was developed. The modified Mouth Breather Quality of Life (MBQoL) questionnaire was submitted to a pretest with a sample of 30 children and adolescents diagnosed with mouth breathing to evaluate comprehension, the order of the items, and the form of administration. The MBQoL questionnaire was then administered to 60 children and adolescents (30 mouth breathers and 30 nose breathers) for the evaluation of construct validity, internal consistency, and reproducibility. All the participants answered the questionnaire, and 50% of each group answered the questionnaire a second time after a 1-week interval (test-retest).

RESULTS

Higher MBQoL scores (which indicated poorer quality of life) were significantly associated with mouth breathing. The Cronbach α coefficient for the items of the questionnaire was 0.88, and the Spearman correlation coefficient for test-retest reliability demonstrated that the questionnaire was reproducible (r = 0.993; p < 0.01).

CONCLUSION

Through this validation study, the MBQoL questionnaire demonstrated a good performance in the evaluation of the quality of life of children and adolescents with mouth breathing and may be a useful tool in clinical studies as well as public health programs. However, further studies are needed to establish its applicability in other populations with respiration disorders.