Crescimento infantil comparado com as referências NCHS e o padrão WHO/2006

[Growth rate of children of a cohort up to the sixth month of life]

The scope of this article is to investigate factors that contributed to the growth rate of children from birth through the sixth month of life. It involves a cohort study with 144 children observed at birth and in the first, second and sixth months of life. Child head circumference (cm/month), weight (g/day) and length (cm/month) rates were compared according to birth, pregnancy, maternal and family characteristics and those related to the food, illness and health care of the child. The female sex and difficulty in breastfeeding contributed to the deceleration of all three growth rates, while maternal non-vaccination against tetanus affected the increase of head circumference and of child length. Severe maternal mental disorder, moderate/severe food insecurity, oatmeal consumption and failure to follow-up the development of the child influenced the head circumference and weight rates. The intake of alcohol during pregnancy, cesarean delivery, mixed/predominant breastfeeding, use of infant formula and episodes of diarrhea/vomiting affected the head circumference, while inadequate prenatal care affected weight, and low-stature mothers and pacifier use affected length. Modifiable factors are highlighted, such as the consumption of oatmeal and infant formula, and the use of pacifiers, which are related to breastfeeding in infants.

Maternal smoking during pregnancy and early development of overweight and growth deficit in children: an analysis of survival

Abstract Objectives: to evaluate the association between smoking during pregnancy and nutritional status. Methods: cohort study with a sample of 460 children in the baseline. The children were assessed four times, being measured for weight and length to be converted in indexes length forage (L/A) and body mass index forage (BMI/A) in Z-score. The time until occurrence of growth deficit and overweight was calculated in days and compared to maternal smoking during pregnancy. To assess the association between smoking during pregnancy and the outcomes, a Hazard Ratio by Cox regression was obtained, adjusting by confounding variables selected from Directed Acyclic Graphs (DAG). Results: the time until occurrence of growth deficit and overweight was lower in children whose mothers smoked during pregnancy. Smoking during pregnancy was a risk factor for length deficit (HR = 2.84; CI95% = 1.42 to 5.70) and for overweight (HR = 1.96; CI95% = 1, 09 to 3.53), even after the adjustment. Conclusions: maternal smoking was a changeable factor associated with anthropometric outcomes, which demonstrates the need for actions to combat smoking during pregnancy in order to prevent early nutritional deviations.

Determinants of the mean growth rate of children under the age of six months: a cohort study

This study aimed to investigate some factors that contributed to higher or lower growth rate of children up to the sixth month of life. This is a cohort study with 240 children evaluated in four stages. Variables of birth, eating habits of the child, mothers' breast-feeding difficulty and pacifier use were investigated. Children's weight gain rate (grams/day) and size gain (cm/month) were measured in all assessments and compared according to the variables of interest. In the first month, weight gain rate of children born by cesarean section was smaller. By the second month, the growth rate (weight and size gain) was higher among children who were exclusively or predominantly breastfed and lower among those who consumed infant formula. Children of mothers who reported difficulty to breastfeed showed a lower growth rate until the second month. Children age four months who consumed porridge had lower weight and size gain rate. Pacifier use was associated with lower weight gain rates up the first, second and fourth month.

Reasons for human milk donation according to different per capita income

Abstract Objectives: to identify the reasons for human milk donation according to different per capita income in donors who were registered in the human milk bank and center to promote breastfeeding at Instituto de Medicina Integral Professor Fernando Figueira (HMB/CIAMA/IMIP). Methods: this is a cross-sectional study. Data collection was carried out at the HMB/CIAMA/IMIP from March to May 2015. The sample was consisted of 155 donors. The data were obtained by applying a form elaborated by the researchers. For the data analysis the SPSS 13.0 software for Windows and Excel 2010 were used. Results: the reasons most mentioned by the donors with a per capita income of < 0.5 minimum wages were, in descending order: excess of milk /avoid wasting, solidarity, altruism and return to work. Donors with a per capita income of ≥ 0.5 minimum wages were, excess of milk /avoid wasting and return to work were the main reasons for donation, followed by solidarity and altruism. Conclusions: the reasons for human milk donation varied according to the per capita income. This knowledge will contribute with the necessary information for planning/improved interventions to capture new donors locally and nation wide.

Anthropometric indices and exclusive breastfeeding in the first six months of life: a comparison with reference standards NCHS, 1977 and WHO, 2006

BACKGROUND

There is a gap in knowledge on the growth of children exclusively breastfed during the fifth and sixth months of life. This study aimed to assess the growth of infants who were exclusively breastfed for the first 6 months of life and compare the distributions of anthropometric measures based on the National Center for Health Statistics (NCHS, 1977) and World Health Organization (WHO, 2006) curves.

METHODS

Cross-sectional study that measured the weight and length of 360 healthy and exclusively breastfed infants who were enrolled in a primary care program in Belem, Brazil from October 2006 to December 2008. The children were evenly grouped into age groups from 1 to 6 months of age.

RESULTS

The mean weights were higher than the NCHS, 1977 mean weight for all of the studied groups regardless of gender and showed greater similarity to the WHO, 2006 mean weight, especially when standard deviations were considered. Regarding length, although the average length at birth was smaller, females had higher averages in the second and sixth months compared with the reference curves (p < 0.05).

CONCLUSIONS

Exclusive breastfeeding in the first 6 months of life provides adequate physical growth, resulting in height and weight gain curves that are similar to or greater than the NCHS, 1977 and WHO, 2006 curves. The greater mean weight at the fifth and sixth months of life suggests that the second-quarter growth curves of children who are exclusively breastfed are greater than those of children who receive other types of food.

Breastfeeding-Friendly Primary Care Initiative: degree of implementation in a Brazilian metropolis

OBJECTIVE: This study assessed the degree of implementation of the Breastfeeding-Friendly Primary Care Initiative in a Brazilian metropolis. METHODS: A tool with 55 items and a maximum score of 10 points, based on validated protocols, was developed for assessing the degree of implementation of the abovementioned initiative. This tool was used on a probabilistic sample of municipal primary care units in the city of Rio de Janeiro, Brazil (n=56). Managers (n=56), healthcare practitioners (n=541) and users (n=985) were interviewed. RESULTS: The mean score for the degree of implementation of the Breastfeeding-Friendly Primary Care Initiative in the study units was 5.45 (95%CI: 5.11 - 5.78), the maximum being 10.00. Existence of written guidelines and training obtained the worst scores. Breast massage and manual milk expression techniques; knowledge about contraception and the risks associated with the use of baby formulas, bottles, and pacifiers; and existence of support groups obtained intermediate scores. Provision of information and recommendations on breastfeeding rights and advantages; addressing users' worries, life experiences, and doubts; and encouraging cue feeding achieved the best scores. CONCLUSION: The proposed tool assessed the general degree of implementation of the Breastfeeding-Friendly Primary Care Initiative and of each group of actions associated with the "Ten Steps", providing information for restructuring the strategies used in Rio de Janeiro. The degree of implementation of breastfeeding promotion, protection, and support set by the initiative in this city is intermediate, with its items having been implemented to different degrees.