Mechanical stress distribution over the palate by different pacifiers assessed by finite element analysis and clinical data

The mechanical behavior of each type of pacifier on rigid structures and their various impacts on orofacial growth have yet to be discovered. The study aimed to evaluate the stress distribution over a child's palate by three types of pacifiers using finite element analysis and clinical and laboratory data. Modulus of elasticity was obtained from 30 specimens comprising 10 of each conventional (A), orthodontic (B), and breast-shaped (C) pacifiers. Tongue strength was assessed in eight 3-year-old children (kPa). A hemi-maxilla model was obtained from 2- to 3-year-old skull tomography, and the images of pacifiers A, B, and C were captured using 3D scanning. The Hypermesh® program generated a mesh of 6-node tetrahedral elements for applying forces in the X, Y, and Z directions to enable a nonlinear analysis. Pacifier B exhibited the highest values for distributed stress on the palate, followed by pacifier A. Pacifier B stimulated the maxilla forward and sideways. In contrast, pacifier A promoted a forward and upward load, favoring a more atresic palate. Pacifiers A and B tended to rotate in the sagittal plane, generating tensions in the anterior incisors and favoring the open bite. Pacifier C exhibited lateral expansion by stress induction over the mid-palatal suture with less influence on incisor inclination. Pacifiers showed different detrimental stress distributions on the palate. This information can be helpful for improving recommendations given to parents.

Evaluation of the effect of nutritive versus non-nutritive pacifiers as adjuncts to local anaesthesia in male neonatal circumcision using the plastibell technique - A prospective randomised controlled study

BACKGROUND

Male circumcision is the most common surgical procedure worldwide and is often carried out for religious, cultural, medical and public health reasons. It is commonly performed during the neonatal period. Many studies have now shown that pain is a common intra- and post-operative complication. To ensure proper analgesia during the procedure, many surgeons opt for the use of pacifiers as an adjunct to anaesthesia during neonatal circumcision. The aim of this study is to compare nutritive pacifiers (NPs) versus non-NPs (NNPs) as adjuncts to local anaesthesia in male neonatal circumcision using the Plastibell technique.

METHODS

A prospective randomised controlled study was carried out between October 2019 and March 2020. A total of 100 neonates were circumcised using the Plastibell technique and randomised into NP (Group A, n = 33), NNP (Group B, n = 33) and controls (Group C, n = 34), respectively. The differences in pain scores using the Neonatal Infant Pain Scale, total crying time and heart rate during circumcision were recorded and assessed.

RESULTS

The age of participants ranged from 5 to 28 days and the weight ranged from 2.5 to 5.0 kg. The overall mean age, birth weight and current weight of the participants were 15.5 ± 6.1 days, 3.4 ± 0.4 kg and 3.5 ± 0.6 kg, respectively. The control group had the highest average pain score of 5.5 (4.5-5.8) compared to the intervention groups with median pain score (NP: 3.3 [1.3-4.3] and (NNP: 4.3 [3.1-5.1], respectively). NPs had significantly lower pain scores (P = 0.023) and reduced total crying time (P = 0.019) at all stages of the circumcision compared to those given NNPs and controls.

CONCLUSION

This study showed that NPs were superior to NNPs in providing additional pain control during male neonatal circumcision.

In vitro antimicrobial effects of green tea, microwaving, cold boiled water, and chlorhexidine on Streptococcus mutans and Candida albicans on silicone pacifiers

Background

This study aimed to compare the antimicrobial effects of green tea, microwaving, cold boiled water, and chlorhexidine (CHX) on Streptococcus mutans and Candida albicans on silicone pacifiers.

Materials and Methods

In this in vitro experimental study, 60 equal-size samples of silicone pacifiers were cut, ultraviolet sterilized, and randomly divided into two groups (n = 30) for immersion in 0.5 McFarland standard suspension of S. mutans and C. albicans. The samples in each group were then randomly divided into five subgroups (n = 6) for disinfection with 0.12% CHX, cold boiled water, green tea, microwaving for 7 min, and distilled water. The sample suspensions were cultured on blood agar (for S. mutans) and Sabouraud dextrose agar (for C. albicans) and incubated. The number of colonies was counted after 24 and 48 h. Data were analyzed using the Kruskal-Wallis and Mann-Whitney tests (P < 0.05).

Results

At 24 and 48 h, the S. mutans colony count was the lowest in CHX and green tea subgroups followed by microwave, cold boiled water, and distilled water subgroups (P < 0.05).

Conclusion

CHX and green tea can significantly decrease the S. mutans and C. albicans colony count on silicone pacifiers.

Prevalence of malocclusion in early childhood and its associated factors in a primary care service in Brazil

PURPOSE

to evaluate the prevalence of malocclusion and its associated factors of children cared for by a PHC Service in Porto Alegre, Brazil.

METHODS

a cross-sectional study nested in a cohort, carried out in 12 Health Care Practices. Of the 414 children in the cohort examined, 268 were assessed for malocclusion. The presence of anterior open bite, posterior and anterior crossbite was evaluated by the criteria of Foster and Hamilton. Socioeconomic variables, breastfeeding habits and pacifier use information were collected through a standardized questionnaire. Data analysis was performed using a hierarchical approach by Poisson Regression with robust variance.

RESULTS

out of the total 268 evaluated, 135 (50.4%) were boys, and the average age was 28.6 (± 11.9) months. Out of the 143 (53.4%) cases of malocclusion, 113 were anterior open bite, 16 were anterior crossbite, 27 were posterior crossbite, and 38 had increased overjet. In the final analysis, it was observed that there was a higher prevalence of malocclusion in children who never breastfed (PR = 1.44; 95%CI 1.00-2.08) and who always used a pacifier to sleep (PR = 1.81; 95%CI 1.14-2.86).

CONCLUSION

the prevalence of malocclusion in this population was high and was associated with behavioral habits, such as the use of pacifier and not breastfeeding.

Evaluation of Effect of Orthodontic Pacifiers in Prevention of Sudden Infant Death Syndrome: A Finite Element Method and Questionnaire Based Study

INTRODUCTION

Considering the morbidity associated with Sudden Infant Death Syndrome (SIDS) and limitations of absence of such syndrome in animals, a retrospective survey based human study and prospective Finite Element Method (FEM) study was planned to evaluate the effect of orthodontic pacifier in prevention of SIDS.

STUDY DESIGN

Two groups, Group I (case) consisting of 48 people, who had lost their infant due to SIDS in past, and Group II (control) consisting of 200 participants with infant in the family, were established. The study was conducted in two parts. An online questionnaire-based survey consisting of 20 multiple choice questions was conducted to establish the correlation of pacifiers in families affected with SIDS. Thereafter, FEM evaluation was carried out in two age groups (up to six months, and between seven to 12 months) with two different pacifiers i.e. conventional and orthodontic, and one human nipples.

RESULTS

12 participants from case group and 170 in control group gave history of using pacifier for their infants between 2 to 6 months. The frequency and duration of use of pacifiers in case group generally increased while infant cried as high as 66 percent in frequency and 75 percent in duration in comparison to 90 percent in control group. FEM analysis showed significant stresses incurred with conventional pacifiers in relation to oral cavity and tongue. Orthodontic pacifiers exhibited human nipple like effect with more pronounced effects on posterior oral cavity and lesser strain on soft and hard tissues.

CONCLUSION

Promising results obtained with survey and positive correlation of FEM data with orthodontic pacifiers indicates the superiority and advantages of orthodontic pacifiers in prevention of SIDS.

Frequency and Predictors of Pacifier Use in the Low Socioeconomic Group of Karachi, Pakistan: A Cross-Sectional Study

Background Pacifier use has been popular for ages. They are prevalent all over the world because of their various perceived benefits. On the other hand, there is a common belief that they do carry health risks as well. Due to these contradicting belief systems, the frequency of their use, and the factors that determine them, need to be thoroughly evaluated. Since Pakistan is a developing country with a low literacy rate, it can be implied that a vast majority of the country's population may lack awareness regarding the advantages and disadvantages of pacifier use, making them incapable of weighing associated risks versus benefits. The data evaluating these factors in this region are however scarce in the published literature. We, therefore, aimed to highlight the frequency and predictors of pacifier use in the low socioeconomic group of Karachi, Pakistan. Materials and methods A descriptive, cross-sectional study was conducted on a sample of 300 mothers visiting a tertiary care hospital in Karachi, Pakistan. We included mothers who had at least one child under the age of two years, and whose child did not have any oro-nasal anomaly that could prevent them from sucking a pacifier. Data were collected using pre-tested questionnaires and analyzed using the Statistical Package for Social Sciences (SPSS version 23.0, IBM Corp., Armonk, NY, US). Frequencies were calculated and presented in the form of tables. The chi-square test was used to determine the significance of all categorical variables. A P-value of <0.05 was considered to be statistically significant. Results Almost half of our respondents (49%) gave pacifiers to their children. A significant number (59%) of these mothers were uneducated. Almost all (97%) of the users had annual household income less than 15,000 Pakistani rupees (PKR); 34% were primiparous and more than two-thirds (71%) had a normal vaginal delivery. Out of all the factors, maternal age less than 20, annual household income less than 15,000 PKR, and primiparity were significantly associated with pacifier use in mothers (P<0.05). Only a half of the users (51%) cleaned the pacifiers by boiling; one-fourth (25%) washed it with water only; while 18% washed it with soap and water. The majority (84%) of the mothers used the pacifier to soothe the baby when upset. Among mothers who did not use a pacifier, about a third (30%) did not do so as they believed it's a bad practice. About one-fourth (27%) believed it was unhygienic. Conclusions Our study highlights the gap in the awareness of mothers regarding pacifier use. Using this data, we can target to disseminate specific information to this population to integrate safe and healthy child care habits in society.

Mothers' false beliefs and myths associated with teething

BACKGROUND

Teething is a physiological process experienced by all children. However, many unrelated illnesses are blamed on teething.

OBJECTIVE

The aim of this study was to assess mothers' beliefs toward teething and to investigate the practices preferred by mothers to alleviate symptoms that might accompany the teething process.

METHODS

A cross-sectional study was conducted in Basra. The study population includes mothers of young children aged (6-30) months who had at least one erupted primary tooth, and who had no history of medical or systemic disease that might affect teething. Two hundred mothers of different age groups and educational backgrounds responded to a questionnaire that included information on the child's age and birth order, mother's age, level of education, occupation, number of children, beliefs toward teething symptoms, and the practices preferred to relieve the attributed symptoms. Data has been presented in numbers and percentages, the Chi-square test was performed where appropriate, and a p value of < 0.05 was considered significant.

RESULTS

All (100%) participants attributed at least one symptom or sign to the teething process. The most common symptoms reported were fever (70%), diarrhea (68.5%), and sleep disturbance (63.5%). Sixty-eight percent of mothers believed teething remedies were effective; only 10 (5%) did not give any treatment. Over half (62%) gave medications, such as antipyretics, antibiotics, and antidiarrheal agents. Some used teething gels (29%), pacifiers (50%), gum massage (22%), and hard foods such as biscuits and carrots (43.5%). Mothers of various educational levels reported attributed symptoms, and the result was statistically significant (p < 0.05). Mothers of a firstborn child were found to have a higher tendency to attribute symptoms to teething than those who had previous experience with children (p < 0.05).

DISCUSSION AND CONCLUSIONS

Teething myths and misconceptions are common among mothers. The study identified a significant number of doctors, dentists, and pharmacists still attribute many symptoms and signs to teething despite the lack of supporting evidence. Therefore, the findings of this study highlight the need for continuous medical education and nationwide prospective studies to eradicate these false beliefs.

Use of Artificial Nipples Among Brazilian Infants and Associated Factors

Transversal study conducted in a Human Milk Bank to evaluate the factors associated with the use of artificial nipples (pacifier and/or nursing bottle) among Brazilian infants. Analyses were performed using the χ2 test and logistic regression analysis. A total of 6017 nursing mothers were evaluated and the use of artificial nipples was reported by 31.3%. The chance of using artificial nipples was higher among infants whose mothers attended antenatal care in private hospitals [odds ratio (OR): 1.61, 95% confidence interval (CI) 1.21-2.14], born in maternities without the Baby-Friendly Hospital Initiative (BFHI) (OR: 18.38, 95% CI 13.50-25.04) and those with adequate birth weight (OR: 2.83, 95% CI 1.99-4.03). A lower chance of using artificial nipples was observed among infants whose mothers had previous breastfeeding experience (OR: 0.76, 95% CI 0.61-0.95), received guidance on breastfeeding during antenatal care (OR: 0.80, 95% CI 0.65-0.98), practiced exclusive breastfeeding (OR: 0.36, 95% CI 0.28-0.45), breastfeeding on demand (OR: 0.66, 95% CI 0.52-0.85) and residents of inland cities/towns (OR: 0.38, 95% CI 0.20-0.72). The findings highlight the importance of breastfeeding guidance during antenatal care and the role of BFHI in clarifying risks associated with artificial nipple use.

Pacifier Use and Breastfeeding: A Qualitative Study of Postpartum Mothers

Objective: Due to the inconclusive evidence supporting the traditional recommendation to avoid early pacifier use among breastfeeding newborns, this study aims to understand what information mothers are receiving from hospital based care providers and their perspectives about pacifier use in the newborn period. Methods: Interviews with mothers of healthy, term newborns during the postpartum hospitalization were conducted in this qualitative study. Results: Qualitative data analysis yielded several major themes that included the following: (1) pacifiers are beneficial for the maternal/infant experience, (2) concerns that pacifiers may interfere with breastfeeding, and (3) concerns about long-term use (including reliance and effect on teeth). Conclusion: Given the maternal perception of benefit and the paucity of high-quality evidence showing harm, further research on the effects of early pacifier use is needed.

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.

Factors in the Hospital Experience Associated with Postpartum Breastfeeding Success

Introduction: Hospitals are in a unique position to promote, protect, and support breastfeeding. However, the association between in-hospital events and breastfeeding success within population-based samples has not been well studied. Materials and Methods: A stratified (by education and birth weight) systematic sample of 5,770 mothers taking part in the Utah Pregnancy Risk Assessment Monitoring System, 2012-2015, were included. Mothers, 2-4 months postpartum, completed the 82-item questionnaire, including if they had ever breastfed their new baby, and if so, current breastfeeding status. Relationships between in-hospital experiences and breastfeeding termination and duration were evaluated via Poisson and Cox proportional hazard regression models, respectively, adjusting for other in-hospital experiences, maternal age, race/ethnicity, maternal education, marital status, smoking, physical activity, delivery method, pregnancy complications, and length of hospital stay. Results: Of all, 94.4% of mothers self-reported breastfeeding initiation, of whom 18.8% had breastfed <2 months, having breastfed on average 3.2 weeks (standard error: 0.07). In fully adjusted models, mothers who reported receiving a pacifier, receiving formula, or had staff help them learn how to breastfeed had a higher prevalence of terminating breastfeeding before 2 months (adjusted prevalence ratio [aPR] = 1.13, 95% confidence interval [CI]: 0.97-1.32; aPR = 1.20, 95% CI: 1.07-1.36; and aPR = 1.25, 95% CI: 1.08-1.34). Conversely, mothers who reported starting and feeding only breast milk in the hospital and receiving a phone number to call for help with breastfeeding had a lower prevalence of breastfeeding termination before 2 months (aPR = 0.72, 95% CI: 0.61-0.86; aPR = 0.57, 95% CI: 0.51-0.64; and aPR = 0.91, 95% CI: 0.80-1.03). Adjusted Cox models showed similar direction of associations. Conclusions: Encouraging mothers to exclusively breastfeed in the hospital, and reducing gift packs containing pacifiers and formula, may be key areas United States hospitals can focus on to increase breastfeeding success. Prospective assessment in other geographical regions is needed to corroborate these findings.

Perspective: Novel Commercial Packaging and Devices for Complementary Feeding

In recent years, so-called baby food pouches and other novel packaging and devices have been marketed for complementary feeding. To date, no experimental studies have been conducted to determine health and nutrition effects or the safety of baby food pouches and related feeding devices. Yet, these products hold the potential to fundamentally change the ways in which infants and children consume solid foods in infancy and early childhood. In this review, a selection of complementary feeding devices and their potential effects on breastfeeding, formula-feeding, safe and appropriate complementary feeding, and the timely transition to family foods are explored. Because manufacturers have innovated older designs of traditional feeding bottles and pacifiers for complementary feeding, perspectives on potential health effects and the safety of devices are drawn from research on feeding bottles and pacifiers. Recommendations include scaling up research on the safety, nutrition, and health impacts of commercial packaging and devices. In addition, manufacturers should ensure that devices conform to consumer product safety commission specifications and that instructions for use are in line with policies protecting pediatric dental health. Marketing of commercial devices and packaging should conform to the International Code of Marketing of Breastmilk Substitutes.

KNOWLEDGE ABOUT THE BENEFITS OF BREASTFEEDING AND DISADVANTAGES OF THE PACIFIER RELATED TO THE MOTHER'S PRACTICE WITH PRETERM INFANTS

OBJECTIVE

To evaluate the knowledge and expectations of mothers of preterm newborn infants admitted in a neonatal intensive care unit about breastfeeding and pacifier use, and to analyze their experience in dealing with the sucking urge in the first months of life.

METHODS

Mothers were interviewed during hospitalization of the newborn in the neonatal intensive care unit and when the infant was six months old. All mothers with availability to participate in the study were included. Exclusion criteria comprised infants with syndromes and neurological disorders and mothers with cognitive impairment, depression, and drug users. Data were analyzed with the SPSS software, with descriptive statistics and chi-square test.

RESULTS

Sixty-two mothers were interviewed in the beginning and 52 at a six-month follow-up. Mothers' expectations concerning breastfeeding were positive when they listed the benefits to the mother (90.3%) and infant (100%). However, they had difficulties maintaining exclusive breastfeeding and used the baby bottle (75.0%), which most mothers (69.4%) had already acquired before the infant was born. The fact of having a pacifier in the infant's layette (43.6%) did not influence its use (p=0.820). This also occurred among mothers who said they would not offer the pacifier due to disadvantages to the mother (80.7%) and infant (96.8%). The previous expectation that the pacifier could bring benefits for mother and infant did not affect its use (p=0.375 and p=0.158).

CONCLUSIONS

Mothers demonstrated prior knowledge about breastfeeding benefits and disadvantages of the pacifiers. However, they changed their view when dealing with the infant and introduced bottles and pacifiers.

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.

Establishing the association between nonnutritive sucking behavior and malocclusions: A systematic review and meta-analysis

BACKGROUND

The authors studied the effects of nonnutritive sucking behavior (NNSB) on malocclusions through a systematic review of association (etiology).

TYPES OF STUDIES REVIEWED

The authors performed a 3-step search strategy, including electronic searches. Studies of healthy participants with a history of active or previous NNSB, for whom specific malocclusion outcomes had been assessed, were eligible for inclusion. The authors considered before-and-after studies, prospective and retrospective (longitudinal) studies, case-control studies, and analytical cross-sectional studies. They excluded reviews, text- and opinion-based articles, conference abstracts, case reports, case-series, and descriptive cross-sectional studies. The authors, using standardized instruments, independently assessed methodological quality and extracted data from the included studies. In situations for which there were sufficient studies, the authors conducted meta-analyses using the random-effects model, supplemented with the fixed-effects model in situations for which statistical heterogeneity was less than 50%, which the authors assessed using the I² statistic.

RESULTS

The authors included 15 identified studies. They found that NNSB was associated with varying risks of developing malocclusions. Pacifier suckers are less likely to develop an increased overjet compared with digit suckers, although the results of a meta-analysis of 7 studies whose investigators had assessed posterior crossbite in the primary dentition demonstrated a significant association with pacifier sucking over digit sucking (n = 5,560; risk ratio, 1.42; 95% confidence interval, 1.18-1.70; P = .0001). Longer duration of NNSB was associated with an increased risk of developing malocclusions. Across-study heterogeneity likely resulted from methodological and sample size differences.

CONCLUSIONS

The authors of this study have confirmed the association between NNSB and the development of malocclusions. This study provides the highest level of evidence on this topic. Pacifiers were associated with a higher risk of developing most malocclusion features when compared with digit sucking.

PRACTICAL IMPLICATIONS

Though malocclusions are of multifactorial etiology, clinicians should inform parents and caregivers about the dental risks of NNSB, an environmental factor that is modifiable. NNSB should be discouraged in order to avoid the development of malocclusions. Future studies should adopt standardized, universally agreed and accepted definitions and classifications when measuring and reporting orthodontic outcome measures. This will help achieve across-study homogeneity.

Pacifier Use and Exclusive Breastfeeding in Brazil

BACKGROUND

Exclusive breastfeeding (EBF) rates for infants younger than 6 months have increased in Brazil, although at the current pace of improvement it would take 6 years to reach an EBF rate of 50%. Thus, it is important to identify relevant modifiable key risk factors for the premature interruption of EBF.

OBJECTIVE

This study aimed to find out if pacifier use is an independent risk factor for the interruption of EBF among Brazilian infants.

METHODS

We conducted secondary cross-sectional data analyses of 2 waves of infant feeding surveys conducted in 1999 and in 2008 in the Brazilian state capitals and Federal District (N = 42 395 children < 6 months). Multivariate logistic regression was used to test the association between pacifier use and the risk of interruption of EBF in a pooled sample and within each survey wave, adjusting for socioeconomic, demographic, and biomedical confounders.

RESULTS

In the pooled sample, a third of the infants were exclusively breastfed (32.7%) and almost 50% had used a pacifier. Whereas EBF prevalence among infants increased from 25.1% in 1999 to 40.3% in 2008, pacifier use prevalence decreased from 58.5% to 41.6% in the same time period. Pacifier use was strongly associated with the risk of interruption of EBF in 1999 (adjusted odds ratio [AOR] = 2.65; 95% confidence interval [CI], 2.38-2.94), in 2008 (AOR = 3.18; 95% CI, 2.81-3.60), and in the pooled sample (AOR = 2.77; 95% CI, 2.63-2.91) after adjusting for key confounders.

CONCLUSION

Pacifier use was the strongest risk factor for EBF interruption. Effective strategies to reduce pacifier use among infants younger than 6 months may further improve EBF rates in Brazil.

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.

Non-nutritive sucking for gastro-oesophageal reflux disease in preterm and low birth weight infants

BACKGROUND

Gastro-oesophageal reflux (GOR) is commonly diagnosed in the neonatal population (DiPietro 1994), and generally causes few or no symptoms (Vandenplas 2009). Conversely, gastro-oesophageal reflux disease (GORD) refers to GOR that causes troublesome symptoms with or without complications such as damage to the oesophagus (Vandenplas 2009). Currently there is no evidence to support the range of measures recommended to help alleviate acid reflux experienced by infants. Non-nutritive sucking (NNS) has been used as an intervention to modulate neonatal state behaviours through its pacifying effects such as decrease infant fussiness and crying during feeds (Boiron 2007; Pickler 2004).

OBJECTIVES

To determine if NNS reduces GORD in preterm infants (less than 37 weeks' gestation) and low birth weight (less than 2500 g) infants, three months of age and less, with signs or symptoms suggestive of GORD, or infants with a diagnosis of GORD.

SEARCH METHODS

We performed computerised searches of the electronic databases of the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 9, 2013), MEDLINE (1966 to September 2013), CINAHL (1982 to September 2013), and EMBASE (1988 to September 2013). We applied no language restrictions.

SELECTION CRITERIA

Controlled trials using random or quasi-random allocation of preterm infants (less than 37 weeks' gestation) and low birth weight (less than 2500 g) infants three months of age and less with signs or symptoms suggestive of GORD, or infants with a diagnosis of GORD. We included studies reported only by abstracts, and cluster and cross-over randomised trials.

DATA COLLECTION AND ANALYSIS

Two review authors independently reviewed and selected trials from searches, assessed and rated study quality and extracted relevant data. We identified two studies from the initial search. After further review, we excluded both studies.

MAIN RESULTS

We identified no studies examining the effects of NNS for GORD in preterm and low birth weight infants

AUTHORS' CONCLUSIONS

There was insufficient evidence to determine the effectiveness of NNS for GORD. Adequately powered RCTs on the effect of NNS in preterm and low birth weight infants diagnosed with GORD are required.

Pacifier cleaning practices and risk of allergy development

OBJECTIVE

Immune stimulation through exposure to commensal microbes may protect against allergy development. Oral microbes may be transferred from parents to infants via pacifiers. We investigated whether pacifier cleaning practices affected the risk of allergy development.

METHODS

A birth-cohort of 184 infants was examined for clinical allergy and sensitization to airborne and food allergens at 18 and 36 months of age and, in addition, promptly on occurrence of symptoms. Pacifier use and pacifier cleaning practices were recorded during interviews with the parents when the children were 6 months old. The oral microbiota of the infants was characterized by analysis of saliva samples collected at 4 months of age.

RESULTS

Children whose parents "cleaned" their pacifier by sucking it (n = 65) were less likely to have asthma (odds ratio [OR] 0.12; 95% confidence interval [CI] 0.01-0.99), eczema (OR 0.37; 95% CI 0.15-0.91), and sensitization (OR 0.37; 95% CI 0.10-1.27) at 18 months of age than children whose parents did not use this cleaning technique (n = 58). Protection against eczema remained at age 36 months (hazard ratio 0.51; P = .04). Vaginal delivery and parental pacifier sucking yielded independent and additive protective effects against eczema development. The salivary microbiota differed between children whose parents cleaned their pacifier by sucking it and children whose parents did not use this practice.

CONCLUSIONS

Parental sucking of their infant's pacifier may reduce the risk of allergy development, possibly via immune stimulation by microbes transferred to the infant via the parent's saliva.

Honey pacifier use among an indigent pediatric population

BACKGROUND

Use of honey pacifiers by infants presenting to a pediatric clinic at a county hospital in Houston, Texas, was observed by several of our staff members. Although we could not find any published studies linking the use of honey pacifiers to infant botulism, we also could not find any studies assessing the prevalence of honey pacifier use in general.

METHODS

We conducted a cross-sectional, descriptive study using a novel survey that had 19 items. The survey was administered to the parents of children up to age 12 months presenting to a county hospital pediatric clinic for well-child care in Houston, Texas, from February 2010 to April 2011.

RESULTS

There were 397 respondents. Approximately 11% of the respondents reported using honey pacifiers with their infant children. Reasons for use included tradition, infant preference, and perceived health benefits (eg, helps with constipation or colic). Approximately 20% of the honey pacifier users and 23% of the entire group reported knowledge of honey potentially causing an illness in children <12 months of age. Nearly 40% of all respondents also reported using herbal or folk remedies.

CONCLUSIONS

Honey pacifier use was relatively common among this population, seen in ∼1 out of 10 respondents. A majority of the mothers surveyed (∼80%) were unaware of the potential dangers of giving honey to infants under age 12 months. Herbal medicine use was also common.

Comparison of design, materials selection and characterization of pacifiers produced in Brazil

BACKGROUND

A pacifier is an object designed for use by children aged two weeks to around five years old. Although a convenient and an efficient alternative to children sucking their thumb, its use is highly questionable. With the advancement of medicine and technology, harms related to its use were discovered and were related to poor development of the teeth. Furthermore, the use of some industrial raw materials may cause damage to the child's health during the growing process.

METHOD

This study evaluates different models of pacifiers available on the market, taking into consideration the design, materials and attendance to Brazilian Standards.

RESULTS

The Fourier Transform Infrared Spectroscopy (FTIR) analysis of the five different models of pacifiers indicates the use of different materials. For models A, B and E, the nipple is basically composed of silicone, while the guard is made of polycarbonate. For model C and D, the nipple is basically composed of natural rubber, while the guard and the ring are made of polycarbonate. For model D and E, however, the presence of Bisphenol A (BPA) was also used in composition. For the tensile strength tests, only model C was disapproved.

CONCLUSION

Silicon and natural rubber satisfy the requirements for technical performance. However, this does not take into account hygiene and toxicity as parameters for the selection, which are also important when considering child health.

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