Determinantes da amamentação no primeiro ano de vida em Cuiabá, Mato Grosso

Factors affecting exclusive breastfeeding in the first month of life among Amazonian children

Early life feeding practices can directly affect the growth, development, and survival of a child. This study aimed to estimate the frequency of and factors associated with exclusive breastfeeding (EBF) in the first month of life among Amazonian infants. We used data of 1,523 mother-child pairs of the MINA-Brazil birth cohort study. Mothers were interviewed soon after delivery at baseline and by telephone at 30-45 days postpartum (n = 962, 63.2% of those eligible). Kaplan-Meier survival analysis and accelerated failure-time (AFT) models were used to estimate the probability of EBF and the factors associated with EBF duration in the first month. At 30 days of age, 36.7% of the studied population (95% confidence interval [CI] 33.6-39.8) were exclusively breastfed, with a median duration of 16 days. Considering all eligible children for follow-up, the probability of EBF in the first month was 43.7% (95% CI 40.4-46.8), and the median duration was 30 days. The duration of EBF (time-ratio, TR) was 28% longer among multiparous mothers (TR 1.28; 95% CI 1.11-1.48). The use of a pacifier and the occurrence of wheezing were associated with a reduced EBF duration by 33% (TR 0.67; 95% CI 0.58-0.77) and 19% (TR 0.80; 95% CI 0.70-0.93), respectively. These results highlight that EBF among children in the Brazilian Amazon is considerably below international recommendations, and indicate the immediate need to plan and implement actions to promote and support breastfeeding early in life.

Can parity influence infant feeding in the first six months of life?

This article aims to evaluate the influence of parity on breastfeeding and introduction of complementary feeding in children up to six months after childbirth. Longitudinal study conducted through a convenience sample of mother-child pairs, selected at postpartum and accompanied until the sixth month of infant's life, between 2011 and 2016, in Porto Alegre, Brazil. There was an analysis of the time taken in the first feeding after birth, practice and time of breastfeeding, consumption of other types of milk and introduction of complementary feeding. The sample consisted of 161 dyads, with 74 primiparous and 87 multiparous. Multiparous women breastfed their babies sooner in the first 24 hours post-partum (p = 0.019). The offering of other kinds of milk showed no difference in relation to parity, as the moment of introduction to infant nutrition, although both primiparous and multiparous did it before the age of four months. Parity seemed to influence the timing of first breastfeeding offer, but not the introduction of complementary feeding, although this occurred in an early way. In this sense, it is necessary to disseminate more information about breastfeeding and infant feeding during prenatal and childcare, to improve maternal and child health.

Maternity leave and exclusive breastfeeding

OBJECTIVE

To analyze the association between maternity leave and exclusive breastfeeding and to estimate the prevalence of exclusive breastfeeding in children under six months of life.

METHODS

Cross-sectional study, with mothers of children under six months of life, attended in primary health care units with Breast Milk Collection Services in the municipality of Rio de Janeiro, Brazil, in 2013 (n = 429). We analyzed characteristics concerning: maternal sociodemographic aspects, household, prenatal care, childbirth, maternal lifestyle, the child, health care, and infant feeding. Adjusted prevalence ratios (APR) were obtained by Poisson regression with robust variance according to hierarchical approach, and we kept in the final model variables that were associated (p ≤ 0.05) with exclusive breastfeeding (outcome).

RESULTS

Among the interviewed mothers, 23.1% were on maternity leave and 17.2% were working. The prevalence of exclusive breastfeeding was 50.1%. The maternal work with maternity leave was associated with higher prevalence of the outcome (APR = 1.91; 95%CI 1.32-2.78), compared with mothers who worked without maternity leave.

CONCLUSIONS

Maternity leave has contributed to the practice of exclusive breastfeeding for children under six months of life, which indicates the importance of this benefit in protecting exclusive breastfeeding for women inserted in the formal labor market.

Initial difficulties with breastfeeding technique and the impact on duration of exclusive breastfeeding

Abstract Objectives: the present study aimed to evaluate the influence of initial difficulties in breastfeeding on duration of exclusive breastfeeding. Methods: a prospective study with follow up of nursing mothers and their babies in the first six months of age. The studied population was randomly selected among the Brazilian public health system (SUS, Portuguese acronym) users in three hospitals. The breastfeeding observation protocol was used to collect initial data, which also included socio-demographic, prenatal assistance, delivery care, the postpartum period and the newborn variables. After hospital discharge, data were collected by phone. The multiple regression model was used for statistical analysis. Results: 175 mother-baby binomials were followed. Problems with breasts during the postpartum hospital stay (p= 0.030; OR=2.38; CI95%=1.02-5.48), maternal work outside home (p=0.027; OR=2.12; CI95%=1.03-4.31) and low maternal schooling level (p=0.017; OR=2.13; CI95%=1.10-4.06) were shown to be associated with the early interruption of exclusive breastfeeding before the child has completed 6 months of age. A family income lower than one minimum wage was a protective factor (p=0.048; OR=0.42; CI95%=0.17-0.97). Conclusions: socioeconomic aspects and difficulties in breastfeeding associated with problems with the puerperal breasts stood out as factors which restrict the duration of exclusive breastfeeding.

[Maternal breastfeeding and associated factors in children under two years: the Brazilian National Health Survey, 2013]

The objective was to assess the prevalence of maternal breastfeeding and associated factors in Brazilian children under two years of age. This was a cross-sectional nationwide study in 2013. The outcomes were breastfeeding in children under 24 months and exclusive breastfeeding under six months of age. A hierarchical analysis was performed for associated factors. The analyses were stratified by age (0-5 months and 29 days; 6-11 months and 29 days; 12-23 months and 29 days of age). Prevalence of maternal breastfeeding was 56% for the total sample, and as follows according to age: 80% (0-5 months and 29 days), 62.3% (6-11 months and 29 days), and 40.1% (12-23 months and 29 days). In the adjusted analyses, in all the age brackets, higher prevalence of breastfeeding was associated with consumption of fewer milk products. In children from 6 months to 11 months and 29 days, living in the North of Brazil, black skin color, and the lowest quintile of household assets were associated with higher breastfeeding prevalence. In children from 12 months to 23 months and 29 days of age, higher breastfeeding prevalence was associated with black skin color, consumption of healthy liquids and foods, living in urban areas, head-of-household's higher educational level, and more household assets. Overall prevalence of exclusive breastfeeding was 20.6% and was higher in the South, in families with head-of-household's higher educational level, and more household assets. The prevalence rates for breastfeeding and exclusive breastfeeding of Brazilian children under two years can be considered low. Existing policies to increase the prevalence rates of maternal breastfeeding at any age should be reinforced.

Gestational, perinatal, and postnatal factors that interfere with practice of exclusive breastfeeding by six months after birth

BACKGROUND

Despite evidences indicating the superiority of breastfeeding and recent advances in the indicators of breastfeeding in Brazil, exclusive breastfeeding (EBF) during the first six months after birth continues to be an infrequent practice in the country. The objective of the present study was to determine which gestational, perinatal, and postnatal factors of the mother-baby dyad might be associated with the cessation of EBF by six months after birth.

METHODS

Data were collected at the rooming-in facility of the Reference Center of Women's Health of Ribeirão Preto-Mater (CRSM-Mater) during the postpartum period (24 to 72 h after birth) from December 2012 to April 2013 and by telephone contact between the researcher and participating mothers by six months after birth. Questionnaires were applied to collect data, such as the practice of EBF in the last 24 h in the sixth month after birth. The hierarchical theoretical model was proposed and data were analyzed statistically by log-binomial regression models using SAS 9.3.

RESULTS

The study involved 283 mother-baby dyads in which the mother evaluated did not present pregnancy-puerperal complications that could impede breastfeeding and confirmed the interest in breastfeeding her child. After the telephone contact in the exact sixth month after the birth of each participating baby, 84.8% of the participating mothers reported that they were no longer exclusively breastfeeding their babies. After statistical analysis, we found that there was a significant association between cessation of EBF and maternal report of previous experience with EBF for one month (0.91, 95% CI 0.81, 0.99) and six months (0.81; 95% CI 0.68, 0.94). These practices were associated with the maintenance of EBF and, even after adjustment for maternal socio-demographic variables, this association was maintained (0.85; 95% CI 0.73, 0.99). Thus, there is a greater chance of practicing and maintaining EBF by six months after birth when mother had previous experience with it.

CONCLUSION

The identification of the risk variables associated with cessation of EBF by six months postpartum, such as previous experience with exclusive breastfeeding, may contribute to the effectiveness of EBF intervention and support measures during the first six months after birth.

INITIAL BREASTFEEDING DIFFICULTIES AND ASSOCIATION WITH BREAST DISORDERS AMONG POSTPARTUM WOMEN

OBJECTIVE

To investigate the prevalence of difficulties in adopting initial breastfeeding techniques and their association with breast disorders in postpartum women.

METHODS

The cross-sectional study was carried out with 276 randomly selected mother-baby pairs in rooming-in in 3 hospitals in a city of Minas Gerais State (southeast Brazil). An assessment protocol was established to evaluate the breastfeeding technique used. The association between the variables studied and breast disorders was determined by the chi-square test followed by logistic regression, with significance level set at 0.05.

RESULTS

The main factors indicating difficulties to initiate the breastfeeding techniques were inadequate attachment of the baby to the breast (25%), baby response to the contact with the breast (26.1%) and breast disorders (28.3%). Variables associated with postparturm breast disorders were: adolescent mothers (OR 3.35; 95%CI 1.51-7.44; p=0.003); maternal schooling ≤8 years (OR 2.07; 95%CI 1.01-4.23; p=0.048); and supplement provision to the newborn at the hospital (OR 2.36; 95%CI 1.40-4.92; p=0.003). Mothers working outside the household (OR 0.31; 95%CI 0.16-0.61; p=0.001) served as as protective factor on the multivariate model.

CONCLUSIONS

The main difficulties in initial breastfeeding were associated with breast disorders, and the factors associated with this problem included demographic and social, variables, as well as others related to the care routine adopted by maternity hospitals.

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 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.

Prevalence and associated factors for early interruption of exclusive breastfeeding: meta-analysis on Brazilian epidemiological studies

Abstract Objectives: to summarize Brazilian studies that analyzed the risk factors for Exclusive Breastfeeding (EBF) interruption before the child's six months of life. Methods: systematic review and meta-analysis indexed articles from Bireme, Scielo and Pubmed databases published in the period of January 2000 to December 2015. Results: 22 articles were included in the meta-analysis. The factors related to newborns were observed, such as birth weight (OR= 1.17; CI 95%: 1.05-1.29), female gender (OR= 1,09; CI 95%: 1.04-1.13) and the use of pacifier (OR= 2.29; CI 95%: 1.68-2.91) were the main factors responsible for the increase in the occurrence of EBF interruption. The factors were related to the mother, maternal age below twenty years old (OR= 1.22; CI 95%: 1.12-1.33) low schooling level (OR=1.28; CI 95%: 1.11-1.45), primiparity (OR= 1.17; CI 95%: 1.02-1.32) maternal employment during the postpartum period (OR= 1.26; CI 95%: 1.11-1.41), and low family income (OR= 1.22; CI 95%: 1.08-1.37) contributed significantly to the EBF interruption . Conclusions: the meta-analysis of Brazilian epidemiological studies demonstrated evidences to conclude that below the age of twenty, low schooling, primiparity, maternal employment in the postpartum period and low family income are associated to the interruption of exclusive breastfeeding until 6 months of age. Children with low birth weight, female gender and used a pacifier had greater vulnerability to not be exclusively breastfed. In conclusion, most of these factors can be modified through appropriate public policies throughout the adequate prenatal period to promote exclusive breastfeeding.

Factors associated with exclusive breastfeeding in the first six months of life in Brazil: a systematic review

OBJECTIVE

To identify factors associated with exclusive breastfeeding in the first six months of life in Brazil.

METHODS

Systematic review of epidemiological studies conducted in Brazil with exclusive breastfeeding as outcome. Medline and LILACS databases were used. After the selection of articles, a hierarchical theoretical model was proposed according to the proximity of the variable to the outcome.

RESULTS

Of the 67 articles identified, we selected 20 cross-sectional studies and seven cohort studies, conducted between 1998 and 2010, comprising 77,866 children. We identified 36 factors associated with exclusive breastfeeding, being more often associated the distal factors: place of residence, maternal age and education, and the proximal factors: maternal labor, age of the child, use of a pacifier, and financing of primary health care.

CONCLUSIONS

The theoretical model developed may contribute to future research, and factors associated with exclusive breastfeeding may subsidize public policies on health and nutrition.

Situation of breastfeeding and complementary feeding in a medium-sized municipality in the Ribeira Valley, São Paulo

OBJECTIVE: To analyze the situation of breastfeeding and complementary feeding in the city of Registro, São Paulo. METHODS: This cross-sectional study collected sociodemographic and feeding information of infants aged less than one year who participated in the 2011 multiple vaccine campaign. Breastfeeding and complementary feeding were analyzed by indicators proposed by the World Health Organization. The association between outcomes (exclusive breastfeeding and introduction to complementary feeding) and the explanatory variables (maternal and child characteristics) was investigated by the Poisson model with a robust error variance. RESULTS: We analyzed 713 children. The prevalence of exclusive breastfeeding was 50.0%. Children who were breastfed exclusively on the first day at home (PR=2.40; 95%CI=1.42-4.06) and not given pacifiers (PR=1.95; 95%CI=1.153.30) were more likely to be exclusively breastfed. The complementary feeding indicators showed that 62.1% of the children aged 6 to 8.9 months consumed fruit plus savory mashes. None of the explanatory variables was significantly associated with this outcome. CONCLUSION: The study identified inappropriate infant feeding practices. Such studies can contribute to the proposal of policies, which is particularly important in an unfavorable social development context characterized by the study city.

Association between the use of a baby's bottle and pacifier and the absence of breastfeeding in the second six months of life

Introduction: The World Health Organization recommends breastfeeding for two years or more and advises against bottle feeding and pacifier use.Objective: Investigate the association between bottle feeding and pacifier use, and breastfeeding in the second half-year of life.Methods: Survey in a municipality of Rio de Janeiro state, in 2006, interviewing those responsible for 580 children aged 6-11 months. Bottle feeding and pacifier use, and variables which in the bivariate analysis were associated with the outcome 'absence of breastfeeding' (≥ 0.20), were selected for multiple analysis. Adjusted prevalence ratios were obtained by a Poisson regression model.Results: 40% of the children 6-11 months were not being breastfed, 47% used a pacifier and 57% used a bottle. Pacifier use (PR = 3.245; CI95%: 2.490-4.228) and bottle feeding (PR = 1.605; CI95%: 1.273-2.023) were shown to be strongly associated with the outcome, and also with: mother's low schooling (PR = 0.826; CI95%: 0.689-0.990); low birth weight (PR = 1.488; CI95%: 1.159-1.910); mother not being the baby carer (PR = 1.324; CI95%: 1.080-1.622); and increasing age of the baby in days (PR = 1.004; CI95%: 1.002-1.006).Conclusions: The use of pacifiers and bottles can reduce continued breastfeeding. Stronger discouragement of these artifacts should be adopted in public health policies.

Association between the Brazilian Breastfeeding Network implementation and breastfeeding indicators

OBJECTIVE

To estimate the association between the implementation of the Brazilian Breastfeeding Network and prevalence of breastfeeding in a medium-size city in southern Brazil.

METHODS

This was a cross-sectional study involving 405 children under 1 year who participated in the second phase of the multivaccination campaign in 2012. Children's consumption of food on the day before the interview was obtained through interviews with mothers or guardians. The manager and one health professional from every health facility that joined the Network were interviewed in order to investigate the process of implementation of this initiative. The association between prevalence of breastfeeding and exclusive breastfeeding and adherence to the Network implementation process was tested using Poisson regression with robust variance.

RESULTS

Multivariate analysis revealed that among the children assisted by health facilities who joined the Network and those attending services that did not adhere to this strategy, the prevalence of breastfeeding (74% and 70.4% among children under 1 year, respectively) and exclusive breastfeeding (43.3% and 38.1% among children under 6 months, respectively) did not differ significantly. Difficulties in implementing the Network, such as high turnover of professionals, not meeting the criteria for accreditation, and insufficient participation of tutors in the process were identified.

CONCLUSION

Contrary to the hypothesis of this study, there was no significant association between the implementation of the Brazilian Breastfeeding Network and prevalence of breastfeeding and exclusive breastfeeding in the studied city. It is possible that the difficulties found in implementing the Network in this city have influenced this result.

Factors associated with breastfeeding practice for at least six months in the state of Pernambuco, Brazil

INTRODUCTION

Despite the scientific consensus on the benefits that breastfeeding provides for the mother, the baby, the family and the environment, and also the recommendation to breastfeed exclusively for six months, this practice is far from being achieved.

OBJECTIVE

To analyze the factors associated with exclusive breastfeeding (EBF) for at least six month, as opposed to weaning up to the second month of life in the state of Pernambuco, Brazil.

METHODS

A case-control study of 124 cases (EBF for at least six months) matched for age and sex with 248 controls (weaning up to the second month of life). Cases and controls were drawn from the III State Health and Nutrition Survey. The exposure variables selected were maternal age and education, per capita income, housing zone, prenatal consultations, type of delivery, professional who assisted the delivery, and prenatal breastfeeding guidance. Logistic regression was applied to variables that showed a p-value < 0.2 in the bivariate analysis, and the variables with p-value < 0.05 were included in the final model.

RESULTS

Of the eight groups of variables considered as possible predictors of EBF for at least six months, two remained as associated factors: maternal age between 20 - 35 years old, with odds ratio (OR) 2.5 and 95% confidence interval 95%CI 1.4 - 4.5; and maternal education of 5 - 8 years of schooling (OR 2.1; 95%CI 1.2 - 3.6).

CONCLUSION

The study shows that mobilization of the public sector and stimulus to research is still needed for the success of EBF and for mother and child health.

[The prevalence of exclusive breastfeeding and associated factors: a cross-sectional study of teenage mothers between 14 and 16 years of age in the city of Porto Alegre in the State of Rio Grande do Sul, Brazil]

This is a cross-sectional study to verify the prevalence and associated factors related to exclusive breastfeeding in adolescent mothers between 14 and 16 years of age with 6-month-old or younger babies, born in Porto Alegre in the State of Rio Grande do Sul, Brazil, in 2009. The sample was based on 50% of the newborn babies from the population surveyed. A total of 341 adolescent mothers were interviewed in their homes. The variables considered as potential determinants of exclusive breastfeeding were social and demographic, pre- and post-natal assistance, emotional aspects of the mother, birth conditions and baby characteristics. Prevalence ratios (PR) were estimated by Poisson regression by means of hierarchical analysis. The prevalence of exclusive breastfeeding ranged from 47.8% in the first month of life up to 13.8% after six months and declined, on average, 24% for each month of life (RP = 0.76; CI95%: 0.68-0.85). Besides the baby's age, the factors associated with exclusive breastfeeding were maternal education (PR=1.53; CII95%: 1.18-1.98) and multiple births (PR=1.57; CI95%:1.02-2.46), the latter observed in only 4.7% of the sample. Teenage mothers with higher schooling and with live children from earlier pregnancies manifested higher prevalence of exclusive breastfeeding.

Duration of exclusive breastfeeding in a Brazilian population: new determinants in a cohort study

Background

Determinants of the duration of exclusive breastfeeding (EBF) differ in effect and magnitude across populations. The present study aimed to identify factors associated with discontinuation of EBF in a municipality in northeastern Brazil, including variables that have received little or no attention in previous literature.

Methods

This cohort study involved 1,344 mother-child pairs selected from maternity hospitals in Feira de Santana, Bahia, Brazil. Subjects were followed up for 6 months through monthly home visits, and discontinuation of EBF was recorded. Possible determinants were tested using Cox’s four-level hierarchical survival model, taking into consideration the temporal proximity of the predisposing factors to interruption of EBF. Median duration of EBF was estimated using Kaplan-Meier’s survival curve.

Results

Median duration of EBF was 89 days. Out of the 19 variables tested, 9 showed an association with EBF cessation; of these, two had never been evaluated in Brazilian studies, namely, mother partner’s appreciation for breastfeeding (hazard ratio [HR] 0.62; 95% confidence interval [95% CI] 0.48-0.79) and limiting the number of nighttime feeds at the breast (HR 1.58; 95% CI 1.11-2.23). Another two variables that had been previously evaluated, but had never been described as determinants of discontinuation of EBF showed association: presence of cracked nipples (HR 2.54; 95% CI 2.06-3.13) and prenatal care provided by public services (HR 1.34; 95% CI 1.17-1.55). Other variables showing associations with the outcome were: guidance on breastfeeding received at the hospital (HR 0.80; 95% CI 0.68-0.92), birth in a Baby-Friendly Hospital (HR 0.85; 95% CI 0.73-0.99), less than or equal to 8 years of maternal schooling (HR 1.34, 95% CI 1.17-1.53), mother working outside the home (HR 1.73; 95% CI 1.53-1.95), and use of a pacifier (HR 1.40; 95% CI 1.14-1.71).

Conclusions

The study confirmed that the factors associated with EBF duration are multiple, variable, and dependent on the population being evaluated. Characteristics that had never been previously evaluated or described, at least in Brazilian studies, behaved as determinants of EBF in the present study, and thus allow to expand the existing list of factors determining this practice.

Aleitamento materno como fator de proteção contra a instalação de hábitos bucais deletérios

Objetivo: avaliar a possível associação entre as variáveis sociodemográficas, desmame precoce e o desenvolvimento e manutenção dos hábitos bucais deletérios em crianças de três a cinco anos de idade das creches públicas de Vitória/ES.Método: trata-se de um estudo longitudinal, retrospectivo, com uma amostra final de 903 escolares, aleatorizada e representativa das 9.829 crianças matriculadas. Para a comparação entre as variáveis predictoras e hábitos foi utilizado o teste exato de Fisher e a força da associação medida pelo Odds Ratio.Resultados: 12,4% das crianças apresentaram hábito de sucção digital e 37,7%, o de chupeta. Não foi verificada associação estatisticamente significante do hábito de sucção digital com desmame precoce. As crianças do sexo feminino (p=0,045) demonstraram 20% mais chance de adquirir e permanecer com o hábito de chupeta, e as que tiveram o desmame precoce apresentaram aproximadamente quatro vezes mais a chance de desenvolver o hábito de chupetas (p= 0.000).Conclusão: associação entre hábito de chupeta e desmame precoce foi verificada. O desmame precoce pode ser considerado fator de risco para a permanência do hábito de chupeta.

Influência da orientação sobre aleitamento materno no comportamento das usuárias de um hospital universitário

OBJETIVO: verificar a influência da orientação recebida acerca do aleitamento materno no conhecimento e condutas de mães usuárias de um hospital universitário. MÉTODOS: estudo observacional descritivo realizado com 250 mães, previamente orientadas ou não, a respeito do aleitamento materno, com idade entre 18 e 45 anos, as quais se encontravam no Ambulatório de Fonoaudiologia do Hospital das Clínicas da UFMG para realização de triagem auditiva neonatal e haviam tido filho há no máximo seis meses. Estas mães responderam um questionário a respeito do aleitamento materno. RESULTADOS: as mães que receberam orientação demonstraram maior conhecimento acerca da idade adequada para se ofertar outros alimentos (p=0,001), dos utensílios utilizados para alimentação (p=0,031) da desvantagem da mamadeira (p=0,037) e da chupeta (p=0,019). Somente as mães orientadas tanto no pré quanto no pós-natal relataram utilizar a seringa para alimentação (p=0,045). Além disso, o percentual de mães que amamentam em livre demanda e que sabem como armazenar o leite foi maior entre aquelas que haviam recebido orientação acerca do assunto (p<0,001 e p=0,027). Já a preparação das mamas foi melhor realizada pelas mães não orientadas sobre o assunto (p=0,002). CONCLUSÃO: o presente estudo evidenciou que, dentre as mães entrevistadas, ter recebido orientação sobre o aleitamento materno não determinou maior conhecimento acerca do assunto, ressaltando, assim, a necessidade de se ter uma equipe multidisciplinar atuando nas orientações às mães, bem como a importância da participação do fonoaudiólogo, o qual é o profissional habilitado para abordar questões referentes à prevenção de alterações de motricidade orofacial.

[Breastfeeding-Friendly Primary Care Unit Initiative and the relationship with exclusive breastfeeding]

OBJECTIVE

To analyze the prevalence of exclusive breastfeeding and the association with the Breastfeeding-Friendly Primary Care Unit Initiative.

METHODS

Cross-sectional study, whose data source were research on feeding behaviors in the first year of life conducted in the vaccination campaigns of 2003 and 2006, at the municipality of Barra Mansa, RJ, Southeastern Brazil. For the purposes of this study, infants under six months old, accounting for a total of 589 children in 2003 and 707 children in 2006, were selected. To verify the relationship between being followed-up by Breastfeeding-Friendly Primary Care Unit Initiative units and exclusive breastfeeding practice, only data from the 2006 inquiry was used. Variables that in the bivariate analysis were associated (p-value ≤ 0.20) with the outcome (exclusive breastfeeding practice) were selected for multivariate analysis. Prevalence ratios (PR) of exclusive breastfeeding were obtained by Poisson Regression with robust variance through a hierarchical model. The final model included the variables that reached p-value ≤ 0.05.

RESULTS

The prevalence of exclusive breastfeeding increased from 30.2% in 2003 to 46.7% in 2006. Multivariate analysis showed that mother's low education level reduced exclusive breastfeeding practice by 20.0% (PR = 0.798; 95%CI 0.684;0.931), cesarean delivery by 16.0% (PR = 0.838; 95%CI 0.719;0.976), and pacifier use by 41.0% (PR = 0.589; 95%CI 0.495;0.701). In the multiple analysis, each day of the infant's life reduced exclusive breastfeeding prevalence by 1.0% (PR = 0.992; 95%CI 0.991;0.994). Being followed-up by Breastfeeding-Friendly Primary Care Initiative units increased exclusive breastfeeding by 19.0% (PR = 1.193; 95%CI 1.020;1.395).

CONCLUSIONS

Breastfeeding-Friendly Primary Care Unit Initiative contributed to the practice of exclusive breastfeeding and to the advice for pregnant women and nursing mothers when implemented in the primary health care network.

Rede e apoio social e práticas alimentares de crianças no quarto mês de vida

O objetivo deste trabalho foi investigar a associação entre rede e apoio social e as práticas alimentares de lactentes no quarto mês de vida. Estudo seccional com 294 crianças selecionadas em 4 Unidades de Saúde do município do Rio de Janeiro/RJ/Brasil. Para avaliar as práticas alimentares foi aplicado um recordatório 24h, para medir rede social foram feitas perguntas relacionadas ao número de amigos e parentes "com quem a mãe pode contar" e participação em atividades sociais. A versão em português da escala empregada no "Medical Outcomes Study" foi utilizada para aferir apoio social. Análises foram realizadas por meio de modelos de regressão logística multinomial. A maioria dos lactentes recebeu leite de peito (84%), mas apenas 16% o receberam exclusivamente. Crianças filhas de mães com menor número de parentes com quem contar e com baixo apoio social apresentaram maior chance de estarem em aleitamento artificial em relação ao aleitamento materno exclusivo (AME). Destaca-se a necessidade de integrar os membros da rede social da mulher à atenção pré-natal, ao parto e puerpério para prover o apoio social que atenda as suas necessidades e, assim, contribuir para manutenção do AME.

[Prevalence and determinants of exclusive breastfeeding in the city of Serrana, São Paulo, Brazil]

The objective of this cross-sectional and quantitative study was to identify the prevalence and determinants of exclusive breastfeeding among infants less than six months of age in the city of Serrana, Sao Paulo, Brazil in 2009. A validated semi-structured questionnaire was administered to the guardians of the children less than six months of age who attended the second phase of a Brazilian vaccination campaign against polio. Univariate and multivariate analysis presented in odds ratios and confidence intervals was accomplished. Of the total of 275 infant participants, only 29.8% were exclusively breastfed. Univariate analysis revealed that mothers who work outside the home without maternity leave, mothers who did not work outside the home, adolescent mothers, and the use of pacifiers have a greater chance of interrupting exclusive breastfeeding. In the multivariate analysis, mothers who work outside the home without maternity leave are three times more likely to wean their children early. Results provide suggestions for the redirection and planning of interventions targeting breastfeeding.

[Breastfeeding: knowledge and practice]

The objective of this study was to characterize the practices of breastfeeding promotion developed by nursing professionals of the Family Health Strategy and analyze the correlation between their knowledge of breastfeeding and how often they provided teaching regarding this topic. This cross-sectional, descriptive study was performed at the Family Health Strategy units of Uberaba, Minas Gerais with 85 nursing professionals, using two questionnaires. Data analysis was performed using frequency distribution and Spearman's correlation analysis. Most professionals said that they often addressed breastfeeding in the investigated practices. However, a poor correlation was observed between the frequency of this approach and the mean score on knowledge test. The nursing professionals' statements indicate that breastfeeding recommendations were provided regardless of their knowledge on the topic.

Tempo de aleitamento materno exclusivo em recém-nascidos prematuros e a termo

OBJETIVOS: determinar o tempo de aleitamento materno exclusivo de recém nascidos prematuros e observar se estes apresentam um índice de aleitamento materno exclusivo diferente do apresentado pelo município de Maceió, na I e II Pesquisa de Prevalência de Aleitamento Materno nas Capitais Brasileiras e no Distrito Federal. Além de comparar o tempo de aleitamento materno e aleitamento materno exclusivo de recém nascidos prematuros e a termo e verificar as causas do desmame precoce e suas consequências. MÉTODO: trata-se de uma investigação de campo, de caráter exploratório e longitudinal da prevalência do aleitamento materno exclusivo de recém nascidos prematuro e à termo. RESULTADOS: o percentual de aleitamento materno e de aleitamento materno exclusivo de prematuros aos 6 meses. Houve diferença significante para a variável peso ao nascimento. Dentre as causas do desmame precoce, os fatores educacionais seguidos dos fatores culturais apareceram em maior porcentagem. Como consequência do desmame precoce a prática de hábitos orais ocorreu em 98,1% das crianças. CONCLUSÃO: as crianças prematuras permaneceram mais tempo em aleitamento materno e em aleitamento materno exclusivo que as nascidas a termo. Os fatores educacionais e culturais foram as principais causas do desmame precoce e sua consequência foi o uso de chupeta e mamadeira.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Contributions of the nursing intervention in primary healthcare for the promotion of breastfeeding

This study aimed to analyze the contributions of the Primary Healthcare nursing interventions, with primiparae in the promotion of breastfeeding. This is a quasi-experimental, longitudinal study, with a sample consisting of 151 primiparae, who had less than 28 weeks of pregnancy, with the child living for at least six months after the birth, performed between 15 October 2007 and 29 February 2008. Almost all the women initiated breastfeeding, with a sharp decline verified in the prevalence at six months. The mean duration of breastfeeding was 123.8±68.9 days. The intervention that began in the prepartum and continued into the postpartum period, using various strategies (individual consultation, preparation courses for parenting/childbirth, and domicile visits) and intervention contexts (health services and domicile) had significant effects on the duration of breastfeeding, which was not verified in the prevalence.

Tecnologias de enfermagem para promoção do aleitamento materno: revisão integrativa da literatura

Objetivou-se realizar uma revisão integrativa da literatura sobre os tipos de tecnologias que o enfermeiro tem desenvolvido ou que o mesmo poderia utilizar para a promoção do aleitamento materno. Realizou-se em outubro de 2009 uma busca com os descritores aleitamento materno (breastfeeding), enfermagem (nursing) e tecnologia (technology) nas bases: CINAHL, Scopus, PubMed e LILACS. Encontraram-se 127 referências, das quais dez participaram da análise por atenderem aos critérios de seleção do estudo. Verificou-se que a maioria dos estudos (6 - 60%) foi encontrada no Pubmed, na língua inglesa (8 - 80%) e não citou o tipo de estudo (4 - 40%). Identificaram-se 13 tipos de tecnologias para o cuidado, classificadas como dura (8 - 61,5%) e leve (5 - 38,5%), cujo principal público-alvo foi mães de crianças (9 - 90%), sendo a tecnologia mais utilizada o vídeo/filmagem (4 - 40%). Assim, deve-se estimular o uso de tecnologias, sobretudo as consideradas leves e leves-duras, por serem práticas, facilmente desenvolvidas e aplicáveis.

Práticas de alimentação complementar no primeiro ano de vida e fatores associados

OBJETIVO: Investigar a prevalência de consumo de alimentos complementares e os fatores associados à alimentação complementar oportuna em menores de um ano. MÉTODOS: Participaram do estudo 1 176 crianças, durante a Campanha Nacional de Vacinação de 2003, em São Bernardo do Campo (SP), cujos acompanhantes responderam questionário que incluiu questões sobre a alimentação da criança nas 24 horas precedentes. A estimativa da prevalência de consumo dos alimentos complementares foi realizada por um modelo de regressão logística ajustado por idade; as medianas de introdução de alimentos por análise de sobrevida e os fatores associados à alimentação complementar oportuna por regressão de Poisson com ajuste robusto de variância e seleção hierarquizada de variáveis. RESULTADOS: Observou-se introdução precoce de alimentos complementares: no quarto mês, cerca de um terço das crianças recebiam suco de fruta e um quarto das crianças recebiam mingau, fruta ou sopa, ao passo que a probabilidade de consumir a comida da família aos oito meses foi baixa (48%). A mediana de idade para o consumo de frutas foi de 266 dias (IC95% 256-275), de papa de legumes foi 258 dias (IC95% 250-264) e comida da família, 292 dias (IC 95% 287-303). Os fatores associados ao consumo de alimentos sólidos antes dos seis meses de idade foram: sistema de assistência à saúde; idade materna; trabalho materno e uso de chupeta. CONCLUSÃO: O consumo precoce de alimentos sólidos, um risco potencial para a saúde infantil e para o desenvolvimento de doenças crônicas na idade adulta, evidenciam a necessidade de ações programáticas para reversão deste quadro.

Impacto do incentivo ao aleitamento materno entre mulheres trabalhadoras formais

Investigar se programas de incentivo ao aleitamento materno ajudam a prevenir o desmame precoce entre filhos de mães trabalhadoras. Foi realizado um estudo de intervenção não randomizado, por meio de inquérito entre mães que voltaram a trabalhar após o parto, participantes e não-participantes de um programa de incentivo ao aleitamento. A amostra consistiu de 200 mães de filhos com idades entre 6 e 10 meses. Para avaliar fatores associados ao desmame precoce, os resultados foram analisados por meio dos testes estatísticos de qui-quadrado, exato de Fisher e análise de regressão logística múltipla (α = 0,05). Os resultados mostraram que houve diferença estatística nas taxas de aleitamento materno exclusivo (p < 0,0001) e de aleitamento materno (p < 0,0001) entre os grupos. Apresentou diferença estatística (p = 0,0056) em relação à época de retorno ao trabalho entre os grupos. Não houve diferença entre o fim da licença-maternidade e a época de desmame. As mães que não conseguem amamentar seus filhos durante a jornada de trabalho têm 4,98 (IC95%: 1,27-19,61) vezes mais chances de desmamá-los antes do quarto mês.

Acolhimento e características maternas associados à oferta de líquidos a lactentes

OBJETIVO: Identificar características maternas e ações de acolhimento às mães de crianças menores de seis meses associadas à oferta precoce de líquidos. MÉTODOS: Estudo transversal realizado em 2007 com amostra representativa de mães de crianças menores de seis meses (n = 1.057) usuárias de unidades básicas de saúde (UBS) na cidade do Rio de Janeiro, RJ. Para estimar a associação entre as variáveis explicativas e a oferta de líquidos utilizou-se um modelo de regressão logística multivariado com ponderação, efeito de desenho e controlado pela idade da criança. RESULTADOS: Das mães, 32% não recebeu o cartão de acolhimento na maternidade, 47% não recebeu orientação sobre amamentação na primeira ida à UBS após o parto e 55% relatou a oferta de líquidos aos lactentes. Mulheres sem experiência pregressa em amamentar por pelo menos seis meses apresentaram chance de oferta de líquidos maior que aquelas com experiência (OR = 1,57; IC 95%: 1,16;2,13). As que não receberam orientação sobre amamentação na primeira ida à UBS após o parto tiveram chance 58% maior de oferecer líquidos que aquelas que receberam orientação. A oferta de líquidos mostrou-se positivamente associada com a adolescência entre mulheres com companheiro (OR = 2,17; IC 95%: 1,10;4,30) e negativamente associada com a adolescência entre aquelas sem companheiro (OR = 0,31; IC95%: 0,11;0,85). Entre mulheres com menos de oito anos de estudo, as que não receberam orientação sobre amamentação após o nascimento da criança apresentaram chance de oferta de líquidos 1,8 vez maior que aquelas que receberam orientação. CONCLUSÕES: Idade, situação conjugal e experiência pregressa em amamentar são características maternas associadas à oferta de líquidos para crianças menores de seis meses. O recebimento de orientação precoce sobre aleitamento materno pode reduzir o oferecimento de líquidos aos lactentes.

Exclusive breastfeeding in southern Brazil: prevalence and associated factors

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Tendências temporais e fatores associados à duração do aleitamento materno em Pernambuco

OBJETIVO: Analisar as tendências temporais de duração do aleitamento materno exclusivo e os fatores de proteção. MÉTODOS: Foram analisadas as prevalências de amamentação total e o aleitamento materno exclusivo de lactentes aos quatro meses de idade. Os dados foram obtidos de inquéritos populacionais realizados em 1991, 1997 e 2006, com 935, 2.081 e 1.568 crianças, respectivamente. Os dados foram coletados por entrevista realizada com o responsável pela criança. As prevalências foram analisadas por regressão de Poisson em relação a: condições ambientais, comportamentais e socioeconômicas, variáveis maternas e fatores biológicos da criança. RESULTADOS: A duração mediana do aleitamento total elevou-se de 89 dias (1991) para 106 dias (1997) e, finalmente, 183 dias (2006). A mediana do aleitamento materno exclusivo manteve-se estacionária em torno de 30 dias entre 1997 e 2006. Na análise multivariada, das dez variáveis analisadas, apenas a escolaridade e idade maternas, situação do domicílio e a criança ser do sexo feminino se mantiveram no modelo explicativo final. CONCLUSÕES: Apesar do aleitamento total ter tido importante aumento de duração, o mesmo não ocorreu com a duração do aleitamento materno exclusivo.

Aspectos históricos, científicos, socioeconômicos e institucionais do aleitamento materno

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

Fatores associados à duração mediana do aleitamento materno em lactentes nascidos em município do estado de São Paulo

OBJETIVO: Verificar a prevalência do aleitamento materno entre lactentes, correlacionada com variáveis sócio-demográficas, em Campinas (SP). MÉTODOS: Entre os anos de 2004 e 2005, entrevistadores visitaram 2 857 domicílios de crianças menores de dois anos e aplicaram às mães um questionário estruturado, composto por perguntas sobre nível socioeconômico, amamentação e alimentação complementar. O estudo foi transversal, de base populacional, randomizado, realizado com base nos dados da Declaração de Nascidos Vivos e da prevalência do aleitamento. A duração mediana do aleitamento foi determinada pela análise de sobrevida de Kaplan Méier, e o ajuste do tempo, pela análise multivariada de Cox. A significância estatística adotada foi de 5%. RESULTADOS: A mediana do aleitamento materno exclusivo foi de 90 dias (Intervalo de Confiança - IC95%: 87,6-92,4) e a do aleitamento materno geral foi de 120 dias (IC95%: 117,7-122,3). Com um mês de vida, 66,2% das crianças estavam sendo amamentadas exclusivamente com leite do peito, índice que diminuiu para 2,3% aos seis meses. A introdução mediana para chá (IC95%: 113,2-126,8) e para leite em pó (IC95%: 112,7-127,3) foi de 120 dias. A cor da pele da criança, a escolaridade, a profissão e o estado civil maternos foram fatores associados à duração e ao tipo de amamentação. CONCLUSÃO: Fatores sócio-demográficos podem interferir na duração mediana do aleitamento materno que, embora esteja melhor do que em outros locais do Brasil, está abaixo do padrão recomendado internacionalmente, sugerindo a necessidade de maiores investimentos em relação a este fato, no município.

Fatores associados à introdução precoce de leite artificial, Município do Rio de Janeiro, 2007

Este estudo objetivou analisar a associação entre introdução de leite artificial e fatores demográficos e socioeconômicos em uma amostra representativa de 1.057 mães de crianças menores de seis meses, atendidas em 27 unidades básicas de saúde no Município do Rio de Janeiro, no ano de 2007. As informações sobre características maternas e tipo de alimentação da criança foram obtidas pela aplicação de um questionário à mãe após uma consulta pediátrica. Para estimar a associação entre as variáveis maternas e a introdução de leite artificial foi utilizado um modelo de regressão logística multivariado com ponderação, efeito de desenho e controlado pela idade da criança. Os resultados apontaram que a chance de introdução de leite artificial foi significativamente maior, no nível de 5%, entre as mães com trabalho informal, menos de oito anos de estudo e sem experiência em amamentar. Verificou-se a presença de interação negativa entre situação conjugal e a idade materna. Dentre as mulheres com companheiro, as adolescentes mostraram uma chance 2,06 vezes maior (IC 95% de 1,32 a 3,21) de introduzir leite artificial quando comparadas com as adultas, enquanto entre as mulheres sem companheiro, a adolescência aparece como um fator protetor para a introdução de leite artificial (OR = 0,24, IC 95% 0,10 a 0,58). É necessária a capacitação de profissionais de saúde para oferecer orientações sobre amamentação através de uma abordagem que considere as características maternas.

Determinantes nutricionais e sóciodemográficos da variação de peso no pós-parto: uma revisão da literatura

Trata-se de um estudo de revisão sobre os fatores nutricionais e sócio-demográficos da variação de peso no pós-parto. Foi realizada uma busca bibliográfica nas bases de dados eletrônicas Scientific Eletronic Library On-line (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Medical Literature Analysis and Retrieval System Online (MEDLINE) referente a literatura publicada na última década (1997-2008). Treze artigos, um informe técnico e dois livros considerados relevantes sobre o assunto e publicados anteriormente ao ano 1997 foram citados na revisão. A revisão priorizou estudos de ensaios clínicos randomizados e de seguimento realizados com gestantes e mulheres no pós-parto. Os resultados obtidos mostram como principais fatores associados com a variação de peso no pós-parto o ganho de peso gestacional acima das recomendações do Institute of Medicine, Índice de Massa Corporal Pré-Gestacional > 25 kg/m2, dieta, tempo e intensidade do aleitamento materno e os fatores sócio-demográficos: raça negra, primiparidade, idade materna, baixa renda e baixa escolaridade. A prática regular de atividade física é recomendada como uma estratégia para evitar o ganho de peso excessivo e melhorar a perda de peso durante o pós-parto. No Brasil não existe uma estratégia nacional para prevenir o ganho de peso excessivo e garantir a adequada perda de peso nesse período. Durante o pós-parto, a maioria das ações de saúde visa basicamente garantir o aleitamento materno.

Representações sociais de mães sobre a introdução de alimentos complementares para lactentes

OBJETIVOS: Conhecer as representações de mães sobre a introdução de alimentos complementares e identificar os elementos que constituem o seu processo de escolha. MÉTODOS: Optamos pela pesquisa qualitativa, analisando os dados, das entrevistas de 17 mulheres, à luz dos pressupostos da Representação Social e do Modelo "Pesando Riscos e Benefícios". A estratégia metodológica foi o Discurso do Sujeito Coletivo. RESULTADOS: Emergiramos temas: "Vivenciando o desmame", "Tomando posição ante a alimentação da criança" e "Fazendo as escolhas alimentares propriamente ditas", que versaram sobre a vivência do desmame, os critérios de escolha e as representações maternas acerca da introdução e do alimento complementar. CONCLUSÃO: Com base em suas representações e experiências as mães realizam um movimento de julgamento, interpretação e construção de indicadores, observando o comportamento da criança e buscando, em seu ambiente e em sua visão de mundo, os elementos para tomada de decisão quanto à alimentação do filho.

Aleitamento materno exclusivo em lactentes atendidos na rede pública do município de Joinville, Santa Catarina, Brasil

OBJETIVOS: identificar a prevalência do aleitamento materno exclusivo entre lactentes atendidos na rede pública municipal e sua associação com variáveis maternas e do lactente. MÉTODOS: estudo transversal realizado durante a Campanha Nacional de Vacinação em 2005, em Joinville, Santa Catarina, Brasil. Foi aplicado um questionário aos acompanhantes de 889 lactentes menores de um ano de idade nos postos de vacinação incluindo aspectos maternos e do lactente. Para a análise, utilizou-se estatística descritiva e o teste do qui-quadrado, com nível de significância de 5%. RESULTADOS as prevalências de amamentação foram 90,7%, 84,2% e 73,5%, nos lactentes com idade inferior a quatro, seis e doze meses, respectivamente. O índice de aleitamento materno exclusivo foi de 53,9% em menores de quatro e de 43,6% em menores de seis meses. O uso de chupeta esteve significativamente associado à amamentação não-exclusiva nas crianças com menos de quatro ou seis meses de idade (p<0,001) e o trabalho materno, entre aquelas com até seis meses (p=0,001). CONCLUSÕES: as taxas de amamentação exclusiva entre menores de um ano de idade atendidos na rede pública estão aquém do preconizado pela Organização Mundial da Saúde. O uso de chupeta e o trabalho materno podem interferir negativamente com o aleitamento materno exclusivo.

Influência da escolaridade e do trabalho maternos no aleitamento materno exclusivo

O presente artigo tem por objetivo analisar a associação entre a prática do aleitamento materno exclusivo (AME) e características maternas (idade, escolaridade, paridade e trabalho), peso ao nascer e alimentação no primeiro dia após alta da maternidade, em crianças menores de quatro meses de idade. Para tal, foram utilizados dados de dois inquéritos realizados no município do Rio de Janeiro, em 1998 e 2000. Nesses inquéritos foram realizadas entrevistas com acompanhantes de menores de um ano de idade, selecionados por meio de amostragem probabilística da população de menores de um ano vacinada nos Dias Nacionais de Vacinação (que possuem cobertura universal para esta faixa etária neste município) (n=2.459). A prática do AME foi descrita segundo cada uma das variáveis de exposição e, em seguida, procedeu-se a análise multivariada por regressão logística. A prevalência de AME foi de 22,7% entre os menores de quatro meses, variando de 39,6% no primeiro dia a 12,4% aos 120 dias de vida. Apresentaram maiores prevalências de AME os filhos de mulheres de maior escolaridade, filhos de mulheres que não trabalhavam fora e crianças que estavam em AME no primeiro dia em casa depois da alta da maternidade. Os resultados da análise multivariada indicam associação positiva de AME com escolaridade materna (OR: 1,93 para 3º grau completo) e negativa com trabalho materno (OR: 0,59). A escolaridade e trabalho maternos e alimentação da criança no primeiro dia em casa após alta da maternidade tiveram associação com o AME entre menores de quatro meses de idade.