Pacifier Use and Exclusive Breastfeeding in Brazil

A longitudinal study of breastfeeding relationships at home during the COVID-19 pandemic: A grounded theory method

AIMS

To describe the process of breastfeeding relationships among stay-at-home mother and infant dyads at 1, 3, 5 and 6 months.

DESIGN

A longitudinal qualitative online survey design was used.

METHODS

Data were obtained at 1, 3, 5 and 6 months from 26 breastfeeding mothers who stayed home with their infants and directly breastfed at least once a day for the first 6 months between June 2022 and August 2023. Mothers' written responses to 3 open-ended questions were analysed to assess breastfeeding experiences at home, thoughts/comments while directly breastfeeding and breastfeeding concerns/problems and strategies they used. Based on grounded theory, inductive content analysis was used to analyse the data. Trustworthiness of results was established by coding to consensus, formal peer debriefing and maintaining an audit trail.

RESULTS

'Breastfeeding Relationships at Home,' the core construct, was identified and organized the process of breastfeeding relationships into 5 domains: (1) mothers' emotional well-being while breastfeeding, (2) infant-led feeding, (3) alternatives to breastfeeding, (4) evaluation of breastfeeding and (5) changes in breastfeeding as infants grow older.

CONCLUSION

Breastfeeding is not simply about feeding breast milk but also involves nurturing and developing a relationship between mother and infant. Across the domains, mutual responsiveness, a central element of the breastfeeding relationship was clear. Mothers who were committed to breastfeeding with embedded infant suckling reached emotional well-being in return for their engagement which has potential to reduce maternal stress and prevent postpartum depression.

IMPACT

Findings from the current study add to nurses' knowledge about the relationship building process between stay-at-home mothers and their infants in the first 6 months of breastfeeding during the COVID-19 pandemic. Nurses must remain sensitive to aid the development of breastfeeding relationships in the home environment to maximize mutual responsiveness.

PATIENT OR PUBLIC CONTRIBUTION

No patients or public involved.

Breastfeeding, first-food systems and corporate power: a case study on the market and political practices of the transnational baby food industry in Brazil

BACKGROUND

The exploitative marketing of commercial milk formula (CMF) reduces breastfeeding, and harms child and maternal health globally. Yet forty years after the International Code of Marketing of Breast-Milk Substitutes (The Code) was adopted by WHO member states, many countries are still to fully implement its provisions into national law. Furthermore, despite The Code, worldwide CMF markets have markedly expanded. In this paper, we adopt Brazil as a case study to understand the power of the baby food industry's marketing and corporate political activity, and how this influences the country's 'first-food system' in ways that promote and sustain CMF consumption.

METHODS

We used a case study design, drawing data from from documents and key informant interviews (N = 10).

RESULTS

Breastfeeding rates plummeted in Brazil to a historic low in the 1970s. A resurgence in breastfeeding from the mid-1980s onwards reflected strengthening political commitment for a national policy framework and breastfeeding protection law, resulting in-turn, from collective actions by breastfeeding coalitions, advocates, and mothers. Yet more recently, improvements in breastfeeding have plateaued in Brazil, while the industry grew CMF sales in Brazil by 750% between 2006 and 20. As regulations tightened, the industry has more aggressively promoted CMF for older infants and young children, as well as specialised formulas. The baby food industry is empowered through association with powerful industry groups, and employs lobbyists with good access to policymakers. The industry has captured the pediatric profession in Brazil through its long-standing association with the Brazilian Society of Pediatrics.

CONCLUSION

Brazil illustrates how the baby food industry uses marketing and political activity to promote and sustain CMF markets, to the detriment of breastfeeding. Our results demonstrate that this industry requires much greater scrutiny by regulators.

Infant feeding practices in three Latin American countries in three decades: what demographic, health, and economic factors are relevant?

Introduction

Studies in Latin America have focused either on analyzing factors associated with exclusive breastfeeding (EBF) or infant formula (IF).

Purpose

Analyze the association between economic, sociodemographic, and health factors with EBF, mixed milk feeding (MixMF), and exclusive use of IF in three Latin American and Caribbean countries in the 1990s, 2000s, and 2010s.

Methods

Cross-sectional time-series study using data from Demographic and Health Surveys between the 1990s and 2010s in Colombia (1995-2010), Haiti (1994-2017), and Peru (1996-2012) accounting for a sample of 12,775 infants under 6 months. Hierarchical logistic multilevel regression models were used to estimate the adjusted association between infant feeding outcomes (EBF, MixMF, exclusive use of IF) and contextual level DHS survey decade (1990s, 2000s and 2010s) and economic factors (Gross Domestic Product by purchasing power parity, female wage and salaried workers, labor force participation rate female) as well as individual level sociodemographic (maternal age, maternal education, number of children in the household, wealth index, mother living with a partner, area of residence, mother working outside of home), and health factors (breastfed in the first hour, C-section).

Results

Factors associated with EBF cessation were c-section (OR: 0.76; 95%CI: 0.64, 0.92), mothers working outside of the home (OR: 0.79; 95%CI: 0.69, 0.90), families in the highest income quintile (OR: 0.64; 95%CI: 0.49, 0.84), and female wage and salaried workers (OR: 0.92; 95%CI: 0.91, 0.94). MixMF was associated with women with higher education (OR: 1.54; 95%CI: 1.21, 1.97), mother working outside of the home (OR: 1.26; 95%CI: 1.10, 1.43), c-section (OR: 1.37; 95%CI: 1.15, 1.62), families in the highest income quintiles (OR: 2.77; 2.10, 3.65). and female wage and salaried workers (OR: 1.08;95% CI: 1.05, 1.09). Exclusive use of IF was associated with a mother working outside of the home (OR: 2.09; 95%CI: 1.41, 3.08), c-section (OR: 1.65; 95%CI: 1.09, 2.51), families in the highest income quintiles (OR: 12.08; 95% CI: 4.26, 34.28), the 2010s (OR: 3.81; 95%CI: 1.86, 7.79), and female wage and salaried workers (OR: 1.12; 95%CI: 1.07, 1.16).

Discussion/Conclusion

Factors related to women empowerment and gender equality jeopardized EBF and favored the exclusive use of IF in Latin America. Therefore, workplace interventions to promote, protect, and support breastfeeding practices are key to reducing exclusive use of IF.

Correlation between Pacifier Use in Preterm Neonates and Breastfeeding in Infancy: A Systematic Review

Background: Breastfeeding is very important for the proper nutrition and growth of the child, as well as, the health of the mother. To start breastfeeding, the neonate must have extensive oral capacities for sucking functions but, premature neonates may not have the muscle strength needed to suck successfully. However, the non-nutritive sucking achieved by using a pacifier, has been identified by previous research as a factor associated with shorter duration and exclusivity of breastfeeding. This study aims to perform a systematic review to investigate the relationship between pacifier use in preterm neonates and breastfeeding in infancy. Methods: We included prospective studies, as well as randomized controlled studies that evaluated the association between pacifier use by preterm neonates and of breastfeeding in infancy. Ten research articles from PubMed/Medline, Google Scholar and Crossref were included in the review from a total of 1455 articles. The results differ depending on the type of study.Most prospective studies have shown a negative correlation between pacifier use and breastfeeding, while the randomized controlled studies found a positive correlation. Conclusions: Pacifier use in preterm infants helps transition from tube to oral feeding, breastfeeding, faster weight gain and earlier discharge from the NICU. However, the relationship between pacifiers and breastfeeding is more complicated, as it appears to be influenced by additional risk factors.

Factors Associated With Exclusive Direct Breastfeeding in the First 3 Months

OBJECTIVE

To identify factors associated with exclusive direct breastfeeding in the first 3 months among mother and infant dyads living in the United States.

DESIGN

A secondary analysis of data collected using a cross-sectional online survey completed over a 4-month period in late 2019.

PARTICIPANTS

We recruited a convenience sample of 370 mothers with healthy full-term singleton infants between 1 and 12 weeks of age whose feeding methods consisted of direct breastfeeding at least once a day. Mothers had not returned to work/school at the time of the survey completion.

MEASUREMENTS

The questionnaire consisted of 34 questions about maternal and infant factors that influence decisions about infant feeding, professional support, and parental preferences.

RESULTS

Mothers who practiced feeding on demand (adjusted OR [aOR] = 35.76, 95% confidence interval [CI] [2.04, 500.00]) and mothers of infants 1 to 4 weeks of age (aOR = 2.74, 95% CI [1.54, 4.85]) were more likely to use exclusive direct breastfeeding. The odds of exclusive direct breastfeeding decreased with mothers who breastfed with a nipple shield while in the hospital/birth center/home (aOR = 0.13, 95% CI [0.05, 0.35]), used pacifiers (aOR = 0.31, 95% CI [0.21, 0.65]), or had perceptions of insufficient milk (aOR = 0.11, 95% CI [0.04, 0.26]).

CONCLUSION

Demand feeding and an infant's age of 1 to 4 weeks contributed to exclusive direct breastfeeding. Lower rates of exclusive direct breastfeeding were associated with the use of nipple shields immediately after birth, pacifier use, and perceptions of insufficient milk. Further investigation is warranted to fully differentiate exclusive direct breastfeeding from exclusive breastfeeding.

Socio-demographic, maternal, and infant characteristics associated with early childhood development delays among children of young mothers in Brasília, Brazil

BACKGROUND

Holistic attention to adolescent health is needed to sustain the benefits of investment in early childhood development. Any such interventions must make sure to address the needs of adolescent and young adult parents. This study explored the social and demographic maternal variables associated with risk of early childhood development (ECD) delay for children of young mothers in Brazil.

METHODS

Cross-sectional secondary data analysis was done using data from young mothers (aged 13-24) and their children (aged 0-2), collected from community health centers in Brasília, Brazil, between 2017-2018. The Denver Developmental Screening Test II was used to assess risk of ECD delay outcomes. Descriptive analyses were conducted across the full sample and sub-groups of adolescent (13-19) and young adult (20-24) mothers. Multivariable logistic regressions based on theory modelling approach were conducted for the full sample to examine the associations between maternal age and risk of ECD delay, adjusted for a battery of household, maternal, pregnancy, and infant variables.

RESULTS

Risk of ECD delay was found in 17.39% (N = 76) of the children who participated (N = 437). No significant differences in risk of ECD delay were found for children of adolescent mothers compared to children of young adult mothers. Across the full sample, 60.36% (N = 236) of mothers were living in poverty, 73.17% (N = 319) had 9 or more years of education, and 86.14% (N = 373) were not working outside the home at time of data collection. Furthermore, 90.11% (N = 392) did not identify as head of their household and 73.68% (N = 322) were primiparous. Socially-mediated factors such as lower maternal educational attainment, unemployment, and lack of household support were associated with increased risk of ECD delays for children under age 2. Adjusted logistic regression identified multiparity as an independent maternal factor associated with increased risk of ECD delay (AOR = 2.51; 95% CI, 1.23-5.13).

CONCLUSIONS

Multiparity was the only independent maternal factor associated with ECD delay among children under 2 years old. Other socio-demographic factors relevant to young mothers may influence ECD delays. Ensuring sustained, concurrent attention to children's and young parent's developmental needs may improve multi-generational health outcomes.

Association between deleterious oral habits and asthma in children: a systematic review and meta-analysis

Deleterious oral habits (DOH) have been described as a common finding in pediatric series. Studies have investigated their association with local and systemic health problems. In this study, the association between DOH and asthma was investigated. PubMed, Scopus, Lilacs, Web of Science, Google Scholar, and OpenThesis were accessed to identify observational studies that evaluated the association between DOH (thumb sucking, pacifier use, onychophagia or nail biting, bottle feeding) and asthma in children aged 2-17 years. Information on DOH was obtained from the verbal report of the children's parents. Asthma diagnosis was performed by a physician or using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. We used a random-effects model to pool the results. The odds ratio (OR) was used as measure of association between DOH and asthma. The National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess risk of bias. The GRADE approach was used to assess the quality of evidence. Five studies were included and data from 18,733 children aged 2 to 13 years were analyzed. We found an association between bottle feeding and asthma (OR = 1.25; 95%CI 1.13-1.38; p < 0.001) with moderate level of certainty. Despite the association between pacifier use and asthma (OR = 1.11; 95%CI 1.00-1.24; p = 0.05), the quality of evidence was low. Only one study provided data on nail biting and thumb-sucking, and the individual results showed no association between these habits and asthma. This meta-analysis found an association between bottle feeding, pacifier use, and asthma in children.

Ineffective Feeding Practices and Their Effect on Malocclusion: A Narrative Review

Objective The aim of this narrative review is to highlight the association of ineffective feeding practices with the development of malocclusion in children and the role of a pediatric dentist in identifying the cues and signs of improper feeds, and encourage effective breastfeeding practices.

Introduction There has been an ongoing debate on the role of effective breastfeeding in the prevention of malocclusion. Although no specific claim supports the positive impact of the same, a detailed reviewing of the literature helps to identify the method of feeding to be chosen considering health benefits and personal preference.

Materials and Methods A broad search of all resources linked to the topic was performed in PubMed, Medline, World Health Organization web site, government web sites, and Google Scholar search engine. Keywords used in the search included breastfeeding, ineffective breastfeeding, bottle feeding, pacifier, and malocclusion. A total of 60 articles published in the period from 2000 to 2019 were segregated. Selected articles comprised original research, meta-analysis, and systematic reviews.

Results Parameters such as duration, posture, and non-nutritive sucking habits had an impact on effective breastfeeding.

Discussion Effective breastfeeding and maintaining appropriate posture and duration helps to positively impact the normal growth and development of the jaws, muscular functioning, and speech. Thereby, the risk of developing malocclusion in primary dentition can be prevented.

Conclusion An understanding of the role of breastfeeding and malocclusion will help in the early intervention and prevention of malocclusion and deviated muscular function. Highlighting the role of counseling and effective feeding practices is also an area that should be focused upon by budding clinicians.

Determinants of exclusive breast-feeding discontinuation in southeastern Brazil, 2008-2013: a pooled data analysis

OBJECTIVE

To analyse the determinants of exclusive breast-feeding (EBF) discontinuation in southeastern Brazil between 2008 and 2013.

DESIGN

Secondary cross-sectional data were analysed from three waves of child feeding surveys conducted in the city of Marília, São Paulo, Brazil, in 2008, 2011 and 2013 (n 1645 children under 6 months). Multivariable Poisson regression models were used to test the association between EBF discontinuation and socio-economic, demographic and biomedical factors in a pooled sample and within each survey wave.

SETTING

Regionally representative cross-sectional survey from Brazil.

PARTICIPANTS

The analytical sample included 1645 infants under 6 months old.

RESULTS

In the pooled sample, 40·7 % of the infants were exclusively breastfed. Between 2008 and 2013, there was a significant increase in C-section (35·1-42·7 %) and pacifier use (41·4-48·8 %). The determinants of EBF discontinuation in the pooled analysis were mothers working outside the home (adjusted prevalence ratio (APR) = 1·10; 95 % CI 1·00, 1·21), first-time mothers (APR = 1·10; 95 % CI 1·01, 1·20), pacifier use (APR = 1·48; 95 % CI 1·36, 1·61) and low birth weight (APR = 1·17; 95 % CI 1·05, 1·32).

CONCLUSIONS

Mothers working outside the home, first-time moms, pacifier use and low birth weight were the factors associated with EBF discontinuation. Evidence-based counselling strategies during antenatal and early postpartum care in primary healthcare are needed to address the modifiable determinants of EBF discontinuation and ultimately to improve its rates in southeastern Brazil.

Exclusive Breastfeeding for 6 Months Postpartum and Factors Associated With Success in a Tertiary Care Baby-Friendly Hospital: A Retrospective Cohort Study

It is very important that infants are exclusively breastfed for the first 6 months of life and then that breastfeeding is continued until 2 years of age. In this study, we aimed to determine the rate of exclusive breastfeeding for the first 6 months of life following birth and the factors associated with continuation of exclusive breastfeeding. The study was a retrospective cohort study. The study population consists of infants born in Akdeniz University Hospital. Infants born between June 1, 2016, and June 1, 2017 (n = 1402) were included in the sample. For analysis of data, descriptive statistics, χ2 test, t test, and logistic regression test were employed. The rate of exclusive breastfeeding for the first 6 months was 29.8%. Further analysis revealed that chances of breastfeeding exclusivity for the first 6 months were increased by 1.6-fold if the father had higher education, by 1.4-fold if the infant was not given formula in the hospital, by approximately 4-fold if feeding bottle was not used, and by 1.7-fold in the absence of problems related to breastfeeding. The study results showed that success in exclusive breastfeeding was influenced by several factors. We recommended that modifiable factors associated with the success of exclusive breastfeeding be well managed.

Breastfeeding in the first six months of life for babies seen by Lactation Consulting

OBJECTIVE

to identify breastfeeding patterns, survival of exclusive breastfeeding and factors associated with its interruption, in the first six months of life of babies seen by Lactation Consulting.

METHOD

a prospective cohort, with 231 mother-babies in a Baby-Friendly Hospital. An initial questionnaire was applied after 24 hours of birth, after consulting, as well as a follow-up questionnaire, applied by telephone at 15, 30, 60, 120 and 180 days, with sociodemographic and obstetric variables, maternal habits, father's schooling, birth data and baby feeding. Survival Analysis was carried out.

RESULTS

at 180 days of age, exclusive breastfeeding was 12.7% and the probability was 19.6% in the analysis of the survival curve. The factors associated with its interruption were smoking during pregnancy (HR 1.66; CI 1.05 - 2.61), age ≥ 35 years old (HR 1.73; CI 1.03 - 2.90), difficulty in breastfeeding after hospital discharge (HR 2.09; CI 1.29 - 3.41), search for professional assistance (HR 2.45; CI 1.69 - 3.54) and use of a pacifier (HR 1.76; IC 1.21 - 2.58).

CONCLUSION

lactation consultancy contributed to the improvement of the exclusive breastfeeding rates, although there are opportunities for advances.

"I was determined to breastfeed, and I always found a solution": successful experiences of exclusive breastfeeding among Chinese mothers in Ireland

BACKGROUND

The prevalence of exclusive breastfeeding for at least 4 months was previously found to be very low among Chinese immigrants in Ireland, at 5.8% (Zhou et al., Front Public Health 6:351, 2018). This study investigates the successful experiences of Chinese mothers living in Ireland who exclusively breastfeed for between four and 6 months.

METHODS

Participants were recruited from the sample of the Ireland Chinese Mother Survey. Qualitative in-depth interviews were conducted with fourteen participants in their homes or public places.

RESULTS

A content analysis revealed that various factors contributed to a successful experience of exclusive breastfeeding among the group of Chinese immigrant mothers, including strong self-determination; appropriate physical conditions; awareness of the benefits of exclusive breastfeeding; a lack of time constraints; and family, professional and policy support. The barriers that the mothers faced included the difficulty of balancing breastfeeding and employment, infant health issues, language barriers, an inability to consume the traditional Chinese postpartum diet and a lack of public breastfeeding facilities. Measures taken to overcome these barriers included seeking family support, resting during the lactation period, and pumping breast milk to feed from a bottle when outside the home.

CONCLUSIONS

This study highlights unique factors affecting exclusive breastfeeding among Chinese mothers in Ireland, which may be useful to health care professionals working with Chinese immigrant women internationally.

Exclusive breast-feeding is associated with reduced pacifier sucking in children: Breast-feeding and pacifier-sucking habit

BACKGROUND

Studies suggest that when children do not achieve the emotional satiety and adequate stimulus provided by breast-feeding, they exhibit sucking behaviors. This study aimed to estimate the association from 4 through 6 months of exclusive breast-feeding (EB) postpartum and pacifier-sucking behavior at 12 months of life.

METHODS

A cohort study was conducted with 1,037 infants, born alive and monitored up to 12 months. At 4 and 6 months after birth, the children were classified according to the type of breast-feeding they had received: exclusive, predominant, complementary, or none. The prevalence of pacifier-sucking behavior was calculated, and the association between the 2 events was estimated. Mothers' socioeconomic-demographic characteristics, delivery features, and prenatal care, as well as the biological characteristics of the children, were determined. Relative risk (RR) and 95% confidence intervals (95% CI) were calculated.

RESULTS

In comparison with EB infants, the RR of pacifier-sucking behavior at 12 months of life was higher in children receiving complementary breast-feeding or no breast-feeding for both 4 months (RR_adjusted, 1.68 [95% CI, 1.39 to 2.02] and RR_adjusted, 2.67 [95% CI, 2.24 to 3.17], respectively) and 6 months (RR_adjusted, 1.43 [95% CI, 1.03 to 2.00] and RR_adjusted, 3.30 [95% CI, 2.40 to 4.54], respectively).

CONCLUSIONS AND PRACTICAL IMPLICATIONS

EB for 6 months postpartum is associated with reduced pacifier-sucking behavior, adjusted for maternal color, number of prenatal consultations, and family income. Promotion of EB may reduce the use of pacifiers and their potential deleterious effects on oral health. Dental health care professionals should consider discussing the importance of breast-feeding with their patients with regard to the possible development of sucking habits in their children.

The association between baby care books that promote strict care routines and infant feeding, night-time care, and maternal-infant interactions

Baby care books that promote strict infant care routines are popular, but little research has considered their impact upon maternal infant care behaviours. We explored whether mothers who have read these books guide their infant care behaviours based on their concepts and how this is associated with infant feeding, night-time care, and response to infant's needs. Three hundred and fifty-four U.K. mothers with a baby aged 0-12 months completed an online questionnaire exploring use of baby care books, motivations for use, whether guidance was followed, and infant care behaviours. Mothers who read the books were drawn to them for information about how to settle their infant, infant sleep, and infant feeding behaviour. Those who read the books were less likely to breastfeed, feed responsively, have their infant sleep in the same room, cuddle their infant to sleep, or respond promptly to infant cries. Although the causality between reading these books and care cannot be determined through this study design, and is likely bidirectional with some reading the books to confirm existing preferences, around 25-40% of mothers noted the information determined their care decisions. Regardless of specific causal pathways, there is an association between these books and behaviours that go against infant feeding and responsive care recommendations. Understanding what drives mothers to follow these books and increasing support for new mothers in these areas is important. The findings will be important for those supporting mothers in the perinatal period in starting conversations around responsive infant care.

Influence of Maternity Leave on Exclusive Breastfeeding: Analysis from Two Surveys Conducted in the Federal District of Brazil

BACKGROUND

Since the 1980s, Brazil has implemented several initiatives to support breastfeeding. Maternity leave, paid in full for 16 weeks, has been available since 1988. However, few studies in Brazil have analyzed the impacts of maternity leave on breastfeeding using population-based indicators.

RESEARCH AIM

The aim was to analyze the association between maternity leave and exclusive breastfeeding interruption in children younger than 4 months residing in the Federal District of Brazil, in 2008 and 2014.

METHODS

Data from two surveys were used: the 2008 Second National Survey on Prevalence of Breastfeeding and the 2014 Monitoring of Infant Feeding Practices. The sample included 1,742 mothers with children younger than 4 months residing in the Federal District and using the Public Unified Health System. The main independent variable was the mother being on maternity leave and the outcome was interruption of exclusive breastfeeding. Multiple analyses were performed to test the association between maternity leave and the risk of interrupting exclusive breastfeeding, adjusting for socioeconomic, demographic, and biomedical characteristics.

RESULTS

In 2008 and 2014, the prevalence of exclusive breastfeeding was 60% and 71.4% and prevalence of maternity leave was 27% and 41%, respectively. The lack of maternity leave was strongly associated with interruption of exclusive breastfeeding in 2008 (prevalence ratio [PR] = 1.78, 95% confidence interval [CI] [1.12, 2.82]) and in 2014 (PR = 3.95, 95% CI [1.88, 8.31]) after adjusting for confounding variables.

CONCLUSION

Not being on maternity leave was strongly associated with the interruption of exclusive breastfeeding among employed women residing in the Federal District.

Nutritive and non-nutritive sucking patterns associated with pacifier use and bottle-feeding in full-term infants

BACKGROUND

The current literature does not provide accurate information about the association between use of artificial nipples and sucking patterns in infants.

AIMS

We aimed to investigate whether pacifier use and/or bottle-feeding were associated with nutritive sucking (NS) and non-nutritive sucking (NNS) patterns.

STUDY DESIGN

Cross-sectional study.

SUBJECTS

429 full-term infants/mothers.

OUTCOME MEASURES

Data were collected through a questionnaire and observations of NS during breastfeeding and NNS (finger sucking). Multivariate logistic regression was used to analyze the adjusted associations between artificial nipple use and between NS and NNS changes.

RESULTS

There were higher frequencies of changes in the NNS and NS patterns in the group that used artificial nipples. Regarding the type of artificial nipple, pacifier use had a greater influence on changes in the NNS pattern whereas the use of a baby bottle presented a greater number of associations with changes in the NS pattern.

CONCLUSION

The findings suggest that the use of artificial nipples may be associated with changes in the sucking patterns of infants, demonstrating the possible existence of nipple confusion and its effect on breastfeeding.

Involvement of maternal grandmother and teenage mother in intervention to reduce pacifier use: a randomized clinical trial

OBJECTIVE

To assess the impact of an intervention for teenage mothers with the involvement of maternal grandmothers on the prevalence of pacifier use in the first six months of life.

METHODS

This randomized clinical trial involved 323 teenage mothers, allocated to four groups: intervention with teenagers only, intervention with teenagers and their mothers, and respective controls. Six breastfeeding counseling sessions, including the recommendation to avoid the use of a pacifier, were delivered at the maternity ward and subsequently at the teenagers' homes, at seven, 15, 30, 60, and 120 days postpartum. Data on infant feeding and pacifier use were collected monthly by interviewers blinded to group allocation. The impact of the intervention was measured by comparing survival curves for pacifier use in the first six months of life and mean time to pacifier introduction.

RESULTS

The intervention had a significant impact on reducing pacifier use only in the group in which grandmothers were involved. In this group, the intervention delayed by 64 days the introduction of a pacifier (21-85 days), compared to 25 days in the group without the participation of grandmothers (65-90 days).

CONCLUSIONS

The intervention reduced pacifier use in the first six months of life and delayed its introduction until beyond the first month when grandmothers were involved. The intervention did not have a significant impact when only teenage mothers were involved.

Exclusive breastfeeding changes in Brazil attributable to pacifier use

BACKGROUND

Identifying key interventions to increase exclusive breastfeeding duration has been a challenge. Pacifier use has been associated with exclusive breastfeeding discontinuation in Brazil. However, the proportion of the improvement in exclusive breastfeeding duration attributable to pacifier use remains unknown.

RESEARCH AIM

Quantify the proportion of increases in exclusive breastfeeding prevalence that can be attributed to reduced pacifier use over time.

METHODS

Secondary data analyses of two nationally representative cross-sectional surveys conducted in States' capitals in 1999 and in 2008 (N = 42,395 Brazilian infants under 6 months of age). We estimated the fraction of exclusive breastfeeding prevalence improvements that could be attributed to pacifier use based on multilevel regression analysis.

RESULTS

From 1999 to 2008, there was an increase of 15.2 percentage points in exclusive breastfeeding prevalence and a decrease of approximately 17 percentage points in the prevalence of pacifier use among infants under 6 months. Reduction in pacifier use explained an increase in 5.5 percentage points' exclusive breastfeeding rates. If pacifier use were to decrease from 41.6% (prevalence in 2008) to 14% (as found in New Zealand), there would be an expected additional increase in exclusive breastfeeding of approximately 12 percentage points.

CONCLUSIONS

About one-third of the improvements in EBF prevalence observed in Brazil over a decade can be attributed to the corresponding decline in pacifier use.

Association between pacifier use and bottle-feeding and unfavorable behaviors during breastfeeding

OBJECTIVE

To investigate the association between pacifier use and bottle-feeding and unfavorable behaviors during breastfeeding.

METHOD

A cross-sectional study was conducted with 427 babies/mothers. Socio-demographic, perinatal data, and information about the use of artificial nipples (pacifier and/or bottle) were collected through a questionnaire. The breastfeeding aspects regarding position, affectivity, sucking behavior, baby responses, and breast anatomy were evaluated through observation during breastfeeding. The chi-squared test and the multiple linear regression analysis were used to investigate the association between the variables.

RESULTS

The aspects of breastfeeding that showed higher percentages of the category "poor" were sucking behavior (22.5%) and position (22.2%). The group of infants who used pacifiers and/or bottle showed higher percentages in the poor and fair categories when compared with the good category for all five breastfeeding aspects evaluated (p<0.001). The linear regression analysis revealed that the increase in the number of unfavorable behaviors regarding position, affectivity, sucking behavior, and baby responses were independently associated with both pacifier and bottle use (β positive, p<0.05), while breast anatomy was independently associated only with bottle use.

CONCLUSION

The findings suggest that the use of pacifiers and/or bottle-feeding may be associated with unfavorable behaviors during breastfeeding, especially the use of bottle-feeding.

Effect of the board game as educational technology on schoolchildren's knowledge on breastfeeding1

Objective:

to evaluate the effect of the board game as an educational technology on schoolchildren’s knowledge on breastfeeding.

Method:

cluster-randomized clinical trial, held in nine schools, with 99 children in the third grade of elementary school (control group = 51 and intervention group = 48). The pretest was conducted in both groups; intervention consisted in the application of the educational technology immediately after pretest to the intervention group; and the post-test was applied on the 7th and 30th days to both groups. For the analysis of children’s knowledge on breastfeeding, we considered the pre- and post-test score means, using the Mann-Whitney test - for comparing the means between groups - and the Wilcoxon test - within the same group.

Results:

there was no statistically significant difference between the groups in the pretest. In the follow-up, when comparing the groups, there were higher means in the intervention group, on the 7th (19.68 ±1.788) and on the 30th (20.16±1.260) days, with statistically significant difference. Within the intervention group, there was significant increase of the means in the pretest (15.89±3.082) for the 30th day (20.16±1.260).

Conclusion:

such educational intervention has significantly contributed to the increase in scores of children’s knowledge on breastfeeding for the intervention group. UTN: U1111-1184-7386.

The impact of maternal socio-demographic characteristics on breastfeeding knowledge and practices: An experience from Casablanca, Morocco

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.

Breastfeeding: what changed after a decade?1

Objective:

to analyze the changes in prevalence, median duration and correlates of breastfeeding in a small city in São Paulo state, Brazil.

Method:

analysis of two cross-sectional studies, conducted at intervals of one decade, with 261 and 302 children younger than two years, respectively. We used Kaplan-Meier survival analysis for calculation of the median duration of breastfeeding, and Cox regression for correlates analysis, with significance level of 5%.

Results:

an increase of 33.4% in the prevalence of exclusive breastfeeding and 20.9% in breastfeeding was identified. Regarding the latter, the median duration increased from 7.2 to 12 months. In the most recent study, the median duration was lower in first-born children who used pacifiers, and it was not associated with breastfeeding incentive actions.

Conclusions:

advances in the prevalence and duration of breastfeeding were observed during the 10 year-period, however, pacifier use still remains associated to a shorter median duration of breastfeeding. Our findings contribute to highlighting the need for intensification of nursing actions in the promotion of breastfeeding, and discouragement regarding the use of pacifiers.

Influence of maternity leave on exclusive breastfeeding

OBJECTIVES

To describe the profile of women with children aged under 4 months living in the Brazilian state capitals and in the Federal District according to their working status and to analyze the influence of maternity leave on exclusive breastfeeding (EBF) among working women.

METHODS

This was a cross-sectional study with data extracted from the II National Maternal Breastfeeding Prevalence Survey carried out in 2008. Initially, a descriptive analysis of the profile of 12,794 women was performed, according to their working status and maternity leave and the frequency of maternity leave in the Brazilian regions and capitals. The study used a multiple model to identify the influence of maternity leave on EBF interruption, including 3766 women who declared they were working and were on maternity leave at the time of the interview. The outcome assessed in the study was the interruption of the EBF, classified by the WHO.

RESULTS

Regarding the working status of the mothers, 63.4% did not work outside of their homes and among those who worked, 69.8% were on maternity leave. The largest prevalence among workers was of women older than 35 years of age, with more than 12 years of schooling, primiparous and from the Southeast and South regions. The lack of maternity leave increased by 23% the chance of EBF interruption.

CONCLUSION

Maternity leave contributed to increase the prevalence of EBF in the Brazilian states capitals, supporting the importance of increasing the maternity leave period from four to six months.

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 interruption of exclusive breastfeeding: Systematic review and meta-analysis

Identifying modifiable risk factor for exclusive breastfeeding (EBF) interruption is key for improving child health globally. There is no consensus about the effect of pacifier use on EBF interruption. Thus, the aim of this systematic review was to investigate the association between pacifier use and EBF interruption during the first six month. A search of CINAHL, Scopus, Web of Science, LILACS and Medline; from inception through 30 December 2014 without restriction of language yielded 1,866 publications (PROSPERO protocol CRD42014014527). Predetermined inclusion/exclusion criteria peer reviewed yielded 46 studies: two clinical trials, 20 longitudinal, and 24 cross-sectional studies. Meta-analysis was performed and meta-regression explored heterogeneity across studies. The pooled effect of the association between pacifier use and EBF interruption was 2.48 OR (95% CI = 2.16-2.85). Heterogeneity was explained by the study design (40.2%), followed by differences in the measurement and categorization of pacifier use, the methodological quality of the studies and the socio-economic context. Two RCT's with very limited external validity found a null association, but 44 observational studies, including 20 prospective cohort studies, did find a consistent association between pacifier use and risk of EBF interruption (OR = 2.28; 95% CI = 1.78-2.93). Our findings support the current WHO recommendation on pacifier use as it focuses on the risk of poor breastfeeding outcomes as a result of pacifier use. Future studies that take into account the risks and benefits of pacifier use are needed to clarify this recommendation.

Association Between In-Hospital Pacifier Use and Breastfeeding Continuation and Exclusivity: Neonatal Intensive Care Unit Admission as a Possible Effect Modifier

BACKGROUND

Breastfeeding dyads frequently use pacifiers during the birth hospitalization, but the relationships between this exposure and breastfeeding continuation and exclusivity remain unclear.

MATERIALS AND METHODS

In this secondary analysis of cross-sectional survey data from the CDC Pregnancy Risk Assessment Monitoring System (PRAMS) from 10 U.S. states (AK, AR, CO, ME, MN, NJ, NY, OR, TX, and VT) from 2009 to 2011, we assessed to what extent pacifier use during the birth hospitalization is independently associated with any and exclusive breastfeeding ≥10 weeks.

RESULTS

A total of 37,628 mothers who were chosen by random birth certificate sampling completed surveys at ∼4 months postpartum. Adjusting for multiple pro-breastfeeding hospital practices and maternal and infant demographic characteristics, pacifier exposure during the birth hospitalization was independently associated with decreased odds of breastfeeding ≥10 weeks (adjusted odds ratio [aOR]) 0.71, 95% confidence interval [CI] 0.63-0.80, p < 0.0001) and exclusive breastfeeding ≥10 weeks (aOR 0.70, 95% CI 0.63-0.79, p < 0.0001) among infants admitted to the well-baby nursery, but not among those admitted to the neonatal intensive care unit (NICU).

CONCLUSIONS

In this population study of mothers from 10 U.S. states, pacifier use during the birth hospitalization was associated with decreased odds of breastfeeding and exclusive breastfeeding ≥10 weeks among well-newborn, but not NICU-admitted infants. Pacifier use may be a marker rather than a cause of breastfeeding difficulties, but prospective, randomized studies are needed to help clarify this. Future studies exploring pacifier exposure and breastfeeding outcomes should account for NICU admission as an effect modifier.