Factors associated with prolonged non-nutritive sucking habits in two cohorts of Brazilian children

Parent-perceived oral habits among a group of school children: prevalence and predictors

PURPOSE

Practicing oral habits beyond the normal age range is assumed to be due to underlying psychological disturbance and could result in a deformation of the orofacial structure. The first step in managing such a health condition is to evaluate its size. Thus, this study aimed primarily to assess the prevalence of oral habits among a group of school children aged from 5 to 7 years, in Cairo, Egypt. The secondary aim of the study was to investigate some possible related predictors along with the mother's perception of the child's oral health-related quality of life.

METHODS

A Google form questionnaire was designed, utilizing the third domain of Nordic Orofacial Test-Screen (NOT-S), to assess the presence or absence of oral habits and their types, if reported. Also, there were two global rating items to test the child's oral health-related quality of life from the mother's prospection, along with one item to inquire if the mother thinks that the oral habits are harmful to the child. A total number of 23 schools in Cairo, Egypt were randomly selected, and the link to the Google form was distributed through the parent's groups on social media. All high-quality complete responses were analyzed using the SPSS program, and a Log-binomial regression model was constructed, to determine the significant predictors of practicing oral habits in children.

RESULTS

Among the analyzed 1128 responses, the total number of answers to the third domain of interview part of NOT-S was 1235, with a response rate of (60.39%), no habits were reported in 635 children (51.4%), while nail biting was noted in 21.8%, bruxism in 17.9% and Sucking habits in 8.9%. In total, 63.8% of children who were reported by their parents to be the "only child" didn't practice any habit, and a higher prevalence of oral habits was detected in children with siblings. There was no detectable association between the mother's educational level and practicing any of the habits, although there was an association between the mother's educational level and their awareness of the harmful effect of oral habits on the child. The mothers' answers to the global rating items were not associated with any of the oral habits.

CONCLUSION

The most prevalent oral habit in the current study was the nail-biting habit. The presence of other siblings and the number of siblings were contributory factors in the occurrence of oral habits, while mothers' educational level was not associated with practicing oral habits. The mothers' awareness of the harmful effect of oral habits on the children was not satisfactory, and there was no association between oral health-related quality of life and the children's oral habits, from the mothers' perspective.

Influence of Nonnutritive Sucking Habits on the Oral Carriage of Escherichia coli

OBJECTIVES

This study aimed to evaluate the impact of nonnutritive sucking habits on the presence of oral Escherichia coli.

METHODS

One hundred and twenty children aged 3-5 years old were enrolled in the present case-control study, as follows: 60 children with continuous pacifier and thumb sucking habits (study group) and 60 children without any sucking habits (control group). The children in the two groups were matched in terms of age and gender. Information was gathered from the parents concerning their children using a special sheet. Sterile swabs were taken from both groups and cultured on agar plates. Then, they were subjected to further biochemical tests to identify E. coli species. The mean of the E. coli count was determined for each child. Descriptive, independent t-test and chi-square test statistics were used. The level of significance was set at p < 0.05.

RESULTS

The presence of nonnutritive sucking habits was related to a higher carriage of E. coli among children.

CONCLUSION

Nonnutritive sucking habits may act as a predisposing factor that enhances the colonization of oral E. coli.

Evaluation of masticatory behavior and taste sensitivity after pacifier removal in preschool children: a 1-year follow-up

OBJECTIVE

The aim was to investigate the influence of pacifier removal on the development of masticatory function and taste sensitivity in preschool children.

METHODS

Sixty children (mean age 48.2 months) were divided into two groups: pacifier group (n = 28) and a control group (n = 32), which were evaluated and followed up for a period of 12 months (at baseline, 6 months, and 1 year). Masticatory and swallowing functions were assessed using the Mastication Observation and Evaluation (MOE) protocol and Orofacial Myofunctional Rating (MBGR), respectively. Detection thresholds for sucrose and urea were measured by the staircase method. The two-way ANOVA mixed model was used for time*group interaction analysis.

RESULTS

MOE scores improved significantly over time in both groups, although a significant difference between groups persisted after 1 year. On the other hand, swallowing scores were significantly different at baseline, but within 1 year, the scores were no longer different between groups. Chewing time and the number of cycles were not different between groups and both decreased after 1 year. Sucrose sensitivity was significantly greater in the control group at baseline and changed over time (p < 0.05), being no longer different between groups after 6 months. Bitter sensitivity did not differ over time nor between groups.

CONCLUSIONS

Detection threshold for sucrose differed significantly between children with and without pacifier habit at a mean age of 42 months. Total masticatory function did not self-correct after sucking habit removal within a 1-year period.

CLINICAL RELEVANCE

Children with pacifier habit showed important changes in masticatory function that did not self-correct 1 year after cessation of the habit, highlighting the need for prevention and habit interruption as early as possible.

Factors associated with non-nutritive sucking habits at 2 years of age among very preterm children: EPIPAGE-2 cohort study

BACKGROUND

The association between prolonged non-nutritive sucking habits (NNSHs, ie, sucking pacifiers or fingers) and maxillofacial growth anomalies in the general population has been widely described. Because maturation of sucking abilities is not fully achieved in very preterm infants (<32 weeks' gestation), neonatal services worldwide rely on the use of pacifiers to promote the development of adequate sucking reflexes, possibly prolonging NNSHs during infancy.

OBJECTIVE

We aimed to describe the frequency and to identify factors associated with NNSHs at age 2 years in very preterm children.

METHODS

The study was based on data from EPIPAGE-2, a French national prospective cohort study of preterm births during 2011 that included 2593 children born between 24 and 31 weeks' gestation. The primary outcome was NNSHs at 2 years. Multivariable log-linear regression models with generalized estimation equations were used to study the association between the characteristics studied and NNSHs. Multiple imputations were used to take into account missing data.

RESULTS

The frequency of NNSHs was 69% in the overall sample but higher among girls (adjusted risk ratio [RR] 1.12, 95% confidence interval [CI] 1.05, 1.17), children born from multiple pregnancies (eg, twins/triplets) (RR 1.07, 95% CI 1.00, 1.11), children who were fed by nasogastric tube (RR 1.07, 95% CI 1.01, 1.13), or those who benefitted from developmental care programmes (RR 1.10, 95% CI 1.02, 1.19). The NNSHs frequency was lower if mothers were not born in France (RR 0.70, 95% CI 0.64, 0.77), children had 2 or more older siblings (RR 0.88, 95% CI 0.82, 0.96), or children were breast-fed at discharge (RR 0.90, 95% CI 0.85, 0.95).

CONCLUSIONS

NNSHs at 2 years seemed associated with cultural background, development care programmes, and breast feeding. Whether NNSHs at 2 years among very preterm children are associated with future maxillofacial growth anomalies deserves further attention.

Effect of birth weight and nutritional status on transverse maxillary growth: Implications for maternal and infant health

We analyzed the association between birthweight, nutritional status and transverse maxillary growth in 7- to 9-year-old schoolchildren. We undertook a cross-sectional survey nested in a population-based cohort study of 158 schoolchildren. The participants lived in the urban area of a small town within the Western Brazilian Amazon. The outcome was represented by the upper intermolar distance given in millimeters (mm), as an indicator of the degree of maxillary bone growth in its transverse dimension. The exposures were sex, birthweight, the bottle-feeding pattern operationalized by a scale corresponding to the age of introduction of the bottle and Body Mass Index-for-age z-score (BAZ) at 4 to 6 ys. Path analysis was employed to estimate standardized direct, indirect and total effects of exposures on the outcome using structural equations model (SEM) supported by Mplus 7 program. The values of standardized coefficients (SC) showed significant direct positive effects of sex (SC = 0.203; p = 0.006), birth weight (SC = 0.155; p = 0.030) and BAZ (SC = 0.165; p = 0.014) on transverse maxillary growth. The indirect effects (SC = 0.057; p = 0.012) and the total effect (SC = 0.261; p<0.001) of sex on the outcome were statistically significant. The indirect effects of birth weight on the outcome were not significant (SC = 0.018; p = 0.488), however, the total effect was significant (SC = 0.174; p = 0.011). In conclusion, sex, birthweight, bottle beginning age and BAZ showed association with the transverse growth of the maxillary bone. In addition to contributing to an adequate birth weight of the child, policies and programs that favor prenatal care and conditions to guarantee a full-term birth can positively affect transverse growth of the maxilla. From a Public Health Surveillance point of view, children with reduced birthweight, inadequate breastfeeding pattern and nutritional deficit for age may be more likely to develop atrophy of the jaws which, depending on the severity, may result in malocclusion with an important impact on quality of life.

DIFICULDADES ALIMENTARES EM PRÉ-ESCOLARES, PRÁTICAS ALIMENTARES PREGRESSAS E ESTADO NUTRICIONAL

Objective:

To identify the prevalence of feeding difficulties in preschoolers, its association with epidemiological factors and previous eating habits, and repercussion on nutritional status.

Methods:

Cross-sectional study with a questionnaire given to the mothers of 301 children aged 2-6 years enrolled in public and private kindergartens in Natal, Northeast Brazil, conducted in 2014-2015. Feeding difficulty was assessed according to Kerzner’s criteria, resulting in the profiles “highly selective intake”, “active child with small appetite”, “fear of feeding”, and “child with psychological disorder or neglected”. Association with the following independent variables was analyzed by logistic regression: breastfeeding time, age of cows’ milk and complementary feeding introduction, age range, family income, type of school, mothers’ profile (responsive or nonresponsive), and body mass index (BMI).

Results:

Feeding difficulty was found in 37.2% of cases, with predominance of “highly selective intake” (25.4%). It was not associated with infancy feeding practices, family income or type of school. There were no differences between the BMI Z score means for the groups with and without feeding difficulty (1.0±1.5 SD and 1.1±1.4 SD, respectively). The five-to-six age range had more occurrences (OR 1.8; 95%CI 1.1-2.9). Children of responsive mothers were less likely to have feeding difficulties (OR 0.4; 95%CI 0.2-0.8).

Conclusions:

Feeding difficulties were very frequent. Nutritional status was not impacted by it, and infancy eating habits were not associated with it. Responsive mothers’ profile is a protective factor against eating difficulties and reinforces the importance of behavioral factors and mother-child interaction.

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.

Oral health status in victims of child abuse: a case-control study

BACKGROUND

Few studies have evaluated the oral health status of children with a history of maltreatment.

AIM

This case-control study evaluated oral health in children who were victims of abuse and in child protective services in Curitiba, Brazil.

DESIGN

One hundred twenty-two children who were victims of abuse and 240 children with no history of abuse (mean ages, 8.56 and 8.24 years, respectively) were included in the study. Dental caries were assessed according to the Decayed, Missing, or Filled Teeth index (dmft index and DMFT index) by two calibrated examiners. The presence of anterior open bite and posterior crossbite was recorded. Data were analyzed using bivariate and adjusted odds ratios using a multivariate logistic regression model analyses.

RESULTS

In the case group, we found a higher DMFT index (P < 0.001) and a significantly higher prevalence of missing primary teeth (P = 0.04), untreated decayed permanent teeth (P < 0.001), filled permanent teeth (P < 0.001), and anterior open bite (P = 0.04). Children who were victims of abuse presented an odds ratio of 6.48 (95% CI: 3.52-11.95) for caries in permanent teeth and an odds ratio of 2.28 (95% CI: 1.04-4.99) for open bite.

CONCLUSION

Victims of child abuse had a worse oral health status, demonstrating the need to establish special policies for oral healthcare for this population.

Effects of conventional and orthodontic pacifiers on the dental occlusion of children aged 24-36 months old

AIM

To investigate the effects of conventional and orthodontic pacifiers on the prevalence of malocclusion (MO) considering frequency, duration, and intensity of the sucking habit.

DESIGN

Data were collected at three time-points: birth, T1; (12-24 months old), T2; (24-36 months old), T3 and were divided into three groups: control (GC; 110), without non-nutritive sucking habits; orthodontic pacifiers (GOrth; 55); conventional pacifiers (GConv; 55). A questionnaire was applied. Clinical examination was performed at T3. The groups were compared as to the prevalence and severity of anterior open bite (AOB), accentuated overjet, anterior crossbite, posterior crossbite (PCB).

RESULTS

The use of pacifiers was associated with occurrence of MO compared to GC (P < 0.05). Frequency, intensity, and duration of pacifier use was also associated with of MO. There was significant difference in the prevalence of MO between GConv and GOrth for AOB (P = 0.027). Only GConv exhibited higher odds of PCB compared to GC (P = 0.040). The prevalence of MO was significantly higher in pacifiers users (P < 0.001).

CONCLUSION

The prevalence of MO was higher among children who used pacifiers. According to a general trend, the use of conventional pacifiers was associated to severe anterior open bite and overjet.

Prevalence of Non-Nutritive Sucking Habits and Potential Influencing Factors among Children in Urban Communities in Nigeria

BACKGROUND

The use of non-nutritive sucking materials like pacifiers and fingers poses health challenges to children in resource-limited settings, where hygiene practices and provision of clean water are poor. This study was designed to determine the prevalence of non-nutritive sucking habits and its association with acute diarrhea in children aged 6-23 months in urban communities of Nigeria.

METHODS

In this cross-sectional study, 12 communities from 4 out of 12 geopolitical wards in Ibadan North Local Government Area and 427 mothers of children aged 6-24 months were randomly selected. A pre-tested, interviewer-administered questionnaire was used to obtain information on socio-demographic characteristics, recent history of diarrhea (3 months prior to visit) and use of non-nutritive sucking materials. Descriptive statistics, Chi-square, and logistic regression were used for data analysis at p = 0.05.

RESULTS

Mean age of the children was 13.9 ± 5.3 months and 50.6% were males. Prevalence of non-nutritive sucking was 45.2%. Prevalence of non-nutritive sucking was not significantly different between males (45.8%) and females (44.5%). The odds ratio of engaging in non-nutritive sucking increases by 6.0% with increasing age (OR = 1.06; 1.02; 1.10). More children who were not exclusively breastfed (53.5%) than exclusively breastfed (26.2%) were likely to engage in non-nutritive sucking (OR = 3.25; 95% CI = 2.07, 5.12). Acute diarrhea was more frequently reported in non-nutritive sucking group than the other (OR = 1.51; 95% CI = 1.03, 2.22).

CONCLUSION

Non-nutritive sucking was linked with failure to practice exclusive breastfeeding, worse with increasing age, and predisposes to acute diarrhea. Further studies are necessary to verify the nature of these associations.