All day-long pacifier use and intelligence quotient in childhood: A birth cohort study.

BACKGROUND: Literature on pacifier use remains controversial, but mostly suggests an inverse association with childhood intelligence. OBJECTIVES: The objective of this study was to assess the association between pacifier use and intelligence quotient (IQ) in six-year-old children from a birth cohort. METHODS: Data from 3532 children from the 2004 Pelotas (Brazil) Birth Cohort were analysed. Children were recruited and assessed at birth and followed up at 3 months, and 1, 2, 4, and 6 years. Data on pacifier use duration and intensity were obtained via interviews with mothers in all six follow-up visits. IQ was estimated at 6 years using the Wechsler Intelligence Scale for Children and standardised for the analyses. Crude and adjusted coefficients were calculated (linear regression) for all the data collected in follow-up assessments for pacifier use. RESULTS: IQ was inversely associated with all pacifier use indicators. Children who used a pacifier all day long (ADL) at any follow-up showed an IQ 0.18 (95% confidence interval [CI] 0.11, 0.24) standard deviations below those who never used it ADL, after adjusting for confounders. The strength of association increased with number of assessments reporting ADL pacifier use, from a reduction in IQ of 0.13 (95% CI 0.06, 0.21) to 0.34 (95% CI 0.15, 0.52) standard deviations for ADL use in one and in all four follow-up visits, respectively. CONCLUSIONS: We found a strong association between intense pacifier use up to 4 years of age and lower IQ at 6 years. A dose-response gradient was observed, with greater IQ deficits in children who used a ADL pacifier for longer durations. The mechanisms underlying this association need to be clarified. One hypothesis is that children using a pacifier, especially those who use it more intensely, are less stimulated.

Factors associated with the maintenance of breastfeeding for 6, 12, and 24 months in adolescent mothers.

BACKGROUND: Previous studies have demonstrated that adolescent mothers present a higher risk of not breastfeeding or of early interruption of this practice. Considering the scarcity of studies investigating the determining factors of breastfeeding in adolescent mothers, and the absence of studies exploring the determining factors of breastfeeding maintenance for different periods of time in a single population of adolescent mothers, the aim of this research was to identify factors associated with breastfeeding maintenance for at least 6, 12, and 24 months in adolescent mothers. METHODS: Data analysis from a randomised control trial involving adolescent mothers recruited at a university hospital in southern Brazil. Participants were followed through the first year of life of their infants and reassessed at 4-7 years. Factors associated with any breastfeeding for at least 6, 12, and 24 months were assessed using multivariate Poisson regression. RESULTS: Data for 228, 237, and 207 mothers were available, respectively. Breastfeeding maintenance for at least 6, 12, and 24 months was observed in 68.4, 47.3, and 31.9% of the sample, respectively. Only one factor was associated with breastfeeding maintenance at all outcomes: infant not using a pacifier showed a higher probability of breastfeeding maintenance in the first 2 years. Maternal grandmother breastfeeding support and exclusive breastfeeding duration were associated with breastfeeding maintenance for 6 and 12 months. The other factors evaluated were associated with breastfeeding maintenance at only one of the time points assessed: 6 months, maternal skin color (black/brown); 12 months, female infant and partner breastfeeding support; and 24 months, older paternal age and multiparity. CONCLUSIONS: The present findings shed light upon barriers and facilitators of breastfeeding practices among adolescent mothers. In order to contribute to the challenge of increasing BF duration among adolescent mothers interventions aimed at boosting breastfeeding maintenance among this population should take into consideration the determining factors here identified. Additionally, breastfeeding education and support should be provided continuously as factors influencing these practices vary with time. Thus, support for adolescent mothers during the different stages of breastfeeding need to be tailored to have a positive impact on breastfeeding experience.

Effect of breastfeeding promotion interventions on child growth: a systematic review and meta-analysis.

AIM: To update a previous systematic review and meta-analyses about the effect of breastfeeding promotion interventions on child growth. METHODS: Studies evaluating the effect of any type of breastfeeding promotion intervention on child weight, length (or height) and weight/height (or BMI) were screened. Papers published between 2006 and 2014 were checked using the following databases: PubMed/MEDLINE, Embase, Cochrane Database of Systematic Reviews, Lilacs and SciELO. RESULTS: Sixteen studies were added to 19 other studies identified in the previous review, resulting in 35 studies. Meta-analyses of studies reporting on mean weight, length, weight/length or BMI showed that the interventions had no impact on weight or length/height z scores [pooled effect: 0.03 (95% confidence interval: -0.06;0.12) and 0.03 (95% confidence interval: -0.02;0.08), respectively] and had a modest, but significant, reduction in body mass index/weight-for-height z scores [z score mean difference: -0.06 (95% confidence interval: -0.12;0.00)], which was limited to studies from low- and high-incomes settings. For all three outcomes, there was important heterogeneity among studies, which should be taken into account when interpreting the results. CONCLUSION: Breastfeeding promotion interventions were not associated with significant changes in weight or length, but led to a modest, albeit significant, reduction in body mass index/weight-for-height z scores.

Factors associated with breastfeeding abandonment in the first month after the mother's return to work.

The return to work of lactating mothers has been identified as an important risk factor for breastfeeding interruption. We proposed to identify factors associated with breastfeeding abandonment in the first month after return. 252 women working at a hospital who had children aged 12 to 36 months and who were still breastfeeding when returned to work answered a questionnaire containing questions on sociodemographic characteristics, pregnancy, childbirth, breastfeeding and work-related factors. The associations were estimated using adjusted prevalence ratio (aPR), calculated with the hierarchical Poisson multivariable regression model. The following factors showed a significant association with breastfeeding abandonment: using a pacifier (aPR 4.58), cohabiting with someone other than partner (aPR 3.77), having no intention or having doubts about maintaining breastfeeding after returning (aPR 3.39), having a college degree (aPR 2.66), having no support from the infant's caregiver (aPR 2.26), and infant being older when the woman returned to work (PR 1.16 for each additional month of infant age). Longer duration of exclusive breastfeeding was a protective factor (aPR 0.990). Most of the factors associated with discontinuation of breastfeeding in the first month after the mother's return to work are not directly related to the woman's work.

Psychometric properties of the Child Development Assessment Questionnaire (QAD-PIPAS) for use in population studies involving Brazilian children aged 0-59 months.

OBJECTIVE: To analyze the psychometric properties of the Child Development Assessment Questionnaire (QAD-PIPAS). METHODS: This methodological study was comprised of two axes. The first one aimed to analyze the instrument's construct validity (discriminant and concurrent validity) and internal consistency, and the second one examined test-retest reliability, involving two different samples and procedures. For construct validity and internal consistency, the sample was recruited in Embu das Artes-SP, Brasilia-DF and Recife-PE during the immunization campaign in 2017, involving caregivers of 2005 children under 60 months of age (1295 under 36 and 710 from 37 to 59 months). For the test-retest analysis the sample consisted of 30 children aged 0-59 months old that attended daycare centers in Embu das Artes-SP in 2018. RESULTS: Multivariate analyses of construct validity showed that the QAD-PIPAS was able to identify the association between the outcome (suspected child development delays) and expected risk and protective factors based on Nurturing Care Framework (OMS/UNICEF). A significant positive correlation was achieved between the scores of the QAD-PIPAS and CREDI in six of the eight age groups analyzed, with the most significant correlations being in the age groups from 25 to 30 and 31-36 months. Acceptable internal consistencies were identified in all age groups, with better performance above 36 months of age (Cronbach's alpha between 0.61 to 0.80). We also found an adequate test-retest reliability (global Kappa 0.81). CONCLUSION: The QAD-PIPAS showed evidence of construct validity and reliability to be used in population studies involving children aged 0-59 months during multi-vaccination campaigns in Brazil.

Development and validation of an instrument for monitoring child development indicators.

OBJECTIVE: To create and validate an instrument for child development monitoring. METHODS: Methodological study, based on the World Bank's proposition to monitor child development indicators in low- and middle-income countries. The stages of the study included the following: development of an inventory of items for child development evaluation, based on open access instruments; content validation by a group of experts on the topic, using consensus techniques; selection of questions to describe children and their families; pre-test of the instrument during the vaccination campaign in 2016 in three municipalities, and conducting cognitive interviews. RESULTS: A total of 431 items were sent for the evaluation of the specialists; 77 were initially excluded and the others were evaluated in-person by the group, with 162 items covering the motor, cognitive, language, and socio-emotional domains, distributed in ten age ranges. Questions about health, nutrition, early learning, protection and safety, and responsive care were also included. The instrument was applied by volunteer undergraduate students to 367 mothers of children under 5 years, showing good adherence of the caregivers. The time of application of the questionnaire was, on average, 20minutes. The cognitive interviews allowed the final adjustment of 19 items of the instrument for better understanding by the caregivers. CONCLUSIONS: The instrument created and validated by experts fills a gap, as it allows a comprehensive evaluation of the development of children under 5 years at the population level, using a fast and inexpensive tool, and can be useful for monitoring indicators of development in Brazilian children in vaccination campaigns.

Validation of a tool to evaluate women's satisfaction with breastfeeding for the Brazilian population.

OBJECTIVE: To perform the construct validity and the internal consistency of the Maternal Breastfeeding Evaluation Scale tool, aiming at its application in the Brazilian population. METHODS: Cross-sectional study that applied the tool to 287 Brazilian women 30 days after childbirth. Main component analysis with varimax rotation was used for the factor analysis, verifying the number of subscales and the maintenance or extraction of the components. Four hypotheses were tested using the unpaired Student's t-test for construct validation. The reliability analysis was performed using Cronbach's alpha coefficient. RESULTS: The exploratory factor analysis identified the need to exclude an item and to reformulate the subscales. The results of the construct validity showed that all hypotheses proposed were confirmed: women who were breastfeeding, those who were exclusively breastfeeding, those who did not have problems related to breastfeeding, and those who intended to breastfeed for at least 12 months achieved significantly higher mean values in the scale. The tool showed adequate internal consistency (Cronbach's alpha=0.88, 95% CI: 0.86-0.90), as did the pleasure and fulfillment of the maternal role subscales (0.92, 95% CI: 0.91-0.93%); child growth, development, and satisfaction (0.70; 95% CI: 0.65-0.75); and maternal physical, social, and emotional aspects (0.75, 95% CI: 0.70-0.79). CONCLUSIONS: The validation process of the Brazilian version of the Maternal Breastfeeding Evaluation Scale tool showed that it is valid and reliable tool to be applied to the Brazilian population.

Effectiveness of an intervention to improve breastfeeding knowledge and attitudes among fifth-grade children in Brazil.

This cluster-randomized trial evaluated the effectiveness and residual effect of an educational intervention to improve breastfeeding knowledge and attitudes among fifth grade children of both sexes in Brazil. Schools were considered clusters and analysis of variance was used to compare an intervention group (n = 298) and a control group (n = 253) regarding knowledge, perceptions, and beliefs about breastfeeding before and after the intervention, measured through a standardized 25-item, multiple-choice questionnaire. The scores in the intervention group improved significantly, with the effect lasting at least 3 months. The intervention had greater impact on girls and on students between 9 and 11 years of age when compared with boys and students between 12 and 17 years old and also between students from public schools. Results suggest that pro-breastfeeding interventions in schools improve breastfeeding knowledge and attitudes.

[Exploratory survey of fifth-grade elementary students in relation to breastfeeding]. / Estudo exploratório sobre aleitamento materno entre escolares de quinta série do Ensino Fundamental.

The present study assessed the knowledge, perceptions, beliefs, and experiences related to breastfeeding as expressed by 564 fifth-grade students (both boys and girls). A questionnaire was used, containing 25 objective questions. The t test and chi-squared test were used, based on cluster sampling. The students consistently viewed maternal breast milk as the best food for infants, although only 60% would choose exclusive breastfeeding for their own children. Fewer than 20% replied that children could be breastfed until two years of age. Approximately one-fourth believed that infants should begin receiving other foods at 6 months of age, and 80% also believed in the need for tea and water. Other beliefs included: that breast milk is weak or thin; that tea is good for infant colic; that breastfeeding makes the breasts flaccid; that breast size influences the amount of milk; and that breastfeeding should be interrupted as soon as the infant's first teeth appear. They highlighted the importance of the father participating in the breastfeeding process, but 70% said that the father could help by giving the baby a bottle. There is also an evident need for primary schools to promote measures for a more favorable position towards breastfeeding.

Factors associated with breastfeeding abandonment in the first month after the mother's return to work / Fatores associados ao abandono do aleitamento materno no primeiro mês após o retorno da lactante ao trabalho

Abstract The return to work of lactating mothers has been identified as an important risk factor for breastfeeding interruption. We proposed to identify factors associated with breastfeeding abandonment in the first month after return. 252 women working at a hospital who had children aged 12 to 36 months and who were still breastfeeding when returned to work answered a questionnaire containing questions on sociodemographic characteristics, pregnancy, childbirth, breastfeeding and work-related factors. The associations were estimated using adjusted prevalence ratio (aPR), calculated with the hierarchical Poisson multivariable regression model. The following factors showed a significant association with breastfeeding abandonment: using a pacifier (aPR 4.58), cohabiting with someone other than partner (aPR 3.77), having no intention or having doubts about maintaining breastfeeding after returning (aPR 3.39), having a college degree (aPR 2.66), having no support from the infant's caregiver (aPR 2.26), and infant being older when the woman returned to work (PR 1.16 for each additional month of infant age). Longer duration of exclusive breastfeeding was a protective factor (aPR 0.990). Most of the factors associated with discontinuation of breastfeeding in the first month after the mother's return to work are not directly related to the woman's work.

Resumo O retorno da lactante ao trabalho é apontado como importante fator de risco para interrupção da amamentação. Nós nos propusemos a identificar fatores associados ao abandono da amamentação no primeiro mês após o retorno. Compuseram a amostra 252 servidoras de um hospital com filhos entre 12 e 36 meses e que estavam amamentando quando retornaram ao trabalho, fornecendo informações sobre características sociodemográficas, gestação, parto, amamentação e fatores relacionados ao trabalho. As associações foram estimadas pela razão de prevalência ajustada (RPa), obtida usando modelo hierárquico de regressão multivariada de Poisson. Os seguintes fatores mostraram associação significativa com abandono da amamentação: uso de chupeta (RPa 4,58), coabitação com outra pessoa que não o companheiro (RPa 3,77), não ter intenção ou ter dúvidas sobre amamentar após retorno (RPa 3,39), ter curso superior (RPa 2,66), não ter apoio do cuidador da criança (RPa 2,26) e maior idade da criança quando a mãe retornou ao trabalho (RPa 1,16 para cada mês de idade a mais da criança). Maior duração da amamentação exclusiva foi fator de proteção (RPa 0,990). A maioria dos fatores associados à descontinuidade da amamentação no primeiro mês após retorno da lactante ao trabalho não está diretamente relacionada ao seu trabalho.

Infant feeding: beyond the nutritional aspects.

OBJECTIVE: To draw attention to the importance of interaction between caregiver and child during feeding and the influence of parenting style on dietary habit formation. SOURCE OF DATA: A search was performed in the PubMed and Scopus databases for articles addressing responsive feeding; the articles considered most relevant by the authors were selected. SYNTHESIS OF DATA: The way children are fed is decisive for the formation of their eating habits, especially the strategies that parents/caregivers use to stimulate feeding. In this context, responsive feeding has been emphasized, with the key principles: feed the infant directly and assist older children when they already eat on their own; feed them slowly and patiently, and encourage children to eat but do not force them; if the child refuses many types of foods, experiment with different food combinations, tastes, textures, and methods of encouragement; minimize distractions during meals; and make the meals an opportunity for learning and love, talking to the child during feeding and maintaining eye contact. It is the caregiver's responsibility to be sensitive to the child's signs and alleviate tensions during feeding, and make feeding time pleasurable; whereas it is the child's role to clearly express signs of hunger and satiety and be receptive to the caregiver. CONCLUSION: Responsive feeding is very important in dietary habit formation and should be encouraged by health professionals in their advice to families.

Psychometric properties of the Child Development Assessment Questionnaire (QAD-PIPAS) for use in population studies involving Brazilian children aged 0-59 months

Abstract Objective: To analyze the psychometric properties of the Child Development Assessment Questionnaire (QAD-PIPAS). Methods: This methodological study was comprised of two axes. The first one aimed to analyze the instrument's construct validity (discriminant and concurrent validity) and internal consistency, and the second one examined test-retest reliability, involving two different samples and procedures. For construct validity and internal consistency, the sample was recruited in Embu das Artes-SP, Brasilia-DF and Recife-PE during the immunization campaign in 2017, involving caregivers of 2005 children under 60 months of age (1295 under 36 and 710 from 37 to 59 months). For the test-retest analysis the sample consisted of 30 children aged 0-59 months old that attended daycare centers in Embu das Artes-SP in 2018. Results: Multivariate analyses of construct validity showed that the QAD-PIPAS was able to identify the association between the outcome (suspected child development delays) and expected risk and protective factors based on Nurturing Care Framework (OMS/UNICEF). A significant positive correlation was achieved between the scores of the QAD-PIPAS and CREDI in six of the eight age groups analyzed, with the most significant correlations being in the age groups from 25 to 30 and 31-36 months. Acceptable internal consistencies were identified in all age groups, with better performance above 36 months of age (Cronbach's alpha between 0.61 to 0.80). We also found an adequate test-retest reliability (global Kappa 0.81). Conclusion: The QAD-PIPAS showed evidence of construct validity and reliability to be used in population studies involving children aged 0-59 months during multi-vaccination campaigns in Brazil.

[Influence of grandmothers on breastfeeding practices]. / Influência das avós na prática do aleitamento materno.

OBJECTIVE: To assess the influence of grandmothers on breastfeeding practices. METHODS: This was a prospective study on 601 mothers of normal babies born in a university hospital in the city of Porto Alegre, State of Rio Grande do Sul. Data were collected in the maternity ward and at home, one, two, four and six months after delivery, by means of interviews with the mothers. Information about grandmothers was obtained at the time of the first home visit. Multiple logistic regression was used to test associations between variables related to the grandmothers and the prevalence of breastfeeding. RESULTS: Abandonment of exclusive breastfeeding within the first month was significantly associated with maternal or paternal grandmothers who advised that water or tea (OR=2.2 and 1.8, respectively) and other kinds of milk (OR=4.5 and 1.9, respectively) should be given. Abandonment of breastfeeding within the first six months was associated with maternal and paternal grandmothers who advised that other kinds of milk (OR=2.4 and 2.1, respectively) should be given. Non-daily contact with the maternal grandmother was a protective factor for maintaining breastfeeding until six months. CONCLUSIONS: Grandmothers may have a negative influence on breastfeeding, both on its duration and its exclusivity. This information could be useful in the planning of strategies for promoting breastfeeding.

[The influence of breastfeeding technique on the frequencies of exclusive breastfeeding and nipple trauma in the first month of lactation]. / Influência da técnica de amamentação nas freqüências de aleitamento materno exclusivo e lesões mamilares no primeiro mês de lactação.

OBJECTIVE: To investigate the influence of breastfeeding technique on the frequencies of exclusive breastfeeding and nipple trauma in the first month of lactation. METHODS: We searched for unfavorable parameters of breastfeeding (five related to mother/baby positioning and three related to baby's latch on) in 211 mother-baby pairs in the maternity ward and at day 30, at home. We compared the frequencies of these parameters between mothers practicing or not exclusive breastfeeding at days 7 and 30, and between mothers with or without nipple trauma at the hospital. RESULTS: The number of unfavorable parameters in the maternity ward was similar for mother-baby pairs practicing or not exclusive breastfeeding at day 7 and 30. However, at day 30, it was, on average, lower among those under exclusive breastfeeding, regarding positioning (1.7+/-1.2 vs 2.2+/-1.1; p = 0.009) as well as latch on (1.0+/-0.6 vs 1.4+/-0.6; p < 0.001). The number of unfavorable parameters related to latch on in the maternity ward was similar for women with or without nipple trauma, but women without trauma presented a higher number of unfavorable parameters related to positioning. (2.0+/-1.4 vs 1.4+/-1.2; p = 0.04). CONCLUSIONS: The frequencies of exclusive breastfeeding in the first month and of nipple trauma were not influenced by the breastfeeding technique in the maternity ward, but there was an association between a better technique at day 30 and the practice of exclusive breastfeeding. New studies may help to elucidate whether an improvement in breastfeeding practices over time helps the maintenance of exclusive breastfeeding or whether the introduction of bottle-feeding determines a negative effect on breastfeeding.

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.

Trends in breastfeeding indicators in a city of northeastern Brazil.

OBJECTIVE: To investigate trends in breastfeeding indicators in the city of Feira de Santana, Brazil, and to identify population characteristics that might have influenced this trend. METHODS: Three methodologically comparable cross-sectional surveys performed in 1996, 2001, and 2009 were analyzed. These involved 2,159, 2,319, and 1,471 children younger than 1 year of age who were vaccinated in national multivaccination campaigns in the respective years. A standardized questionnaire was used, containing closed questions on consumption of breast milk and other foods on the day before the survey, along with questions regarding the characteristics of the population. RESULTS: The annual growth of the breastfeeding indicators was 2.1% for breastfeeding in the first hour of life (from 52.2% to 68.9%); 1.1% for breastfeeding among children aged 9 to 12 months (from 45% to 59.6%); and 0.8% for exclusive breastfeeding among infants younger than 6 months (from 36.9% to 47.4%). The median duration of exclusive breastfeeding increased from 52.3 to 84.3 days, and overall breastfeeding from 278 to 376 days. Some changes in the characteristics of the population were observed, which may have positively influenced the evolution of the breastfeeding indicators (better schooling level among the mothers, less use of dummies/pacifiers, and lower proportions of adolescent mothers), or negatively (greater proportions of primiparous mothers and cesarean deliveries, and lower frequency of births in Baby-Friendly Hospitals). CONCLUSION: There were significant advances in breastfeeding indicators, although they are still far from ideal. Changes observed in population characteristics may have positively or negatively influenced this evolution.

Development and validation of an instrument for monitoring child development indicators / Elaboração e validação de um instrumento para monitoramento de indicadores do desenvolvimento infantil

Abstract Objective: To create and validate an instrument for child development monitoring. Methods: Methodological study, based on the World Bank's proposition to monitor child development indicators in low- and middle-income countries. The stages of the study included the following: development of an inventory of items for child development evaluation, based on open access instruments; content validation by a group of experts on the topic, using consensus techniques; selection of questions to describe children and their families; pre-test of the instrument during the vaccination campaign in 2016 in three municipalities, and conducting cognitive interviews. Results: A total of 431 items were sent for the evaluation of the specialists; 77 were initially excluded and the others were evaluated in-person by the group, with 162 items covering the motor, cognitive, language, and socio-emotional domains, distributed in ten age ranges. Questions about health, nutrition, early learning, protection and safety, and responsive care were also included. The instrument was applied by volunteer undergraduate students to 367 mothers of children under 5 years, showing good adherence of the caregivers. The time of application of the questionnaire was, on average, 20 minutes. The cognitive interviews allowed the final adjustment of 19 items of the instrument for better understanding by the caregivers. Conclusions: The instrument created and validated by experts fills a gap, as it allows a comprehensive evaluation of the development of children under 5 years at the population level, using a fast and inexpensive tool, and can be useful for monitoring indicators of development in Brazilian children in vaccination campaigns.

Resumo Objetivo: Elaborar e validar um instrumento para o monitoramento de indicadores do desenvolvimento infantil. Métodos: Estudo metodológico baseado na proposta do Banco Mundial para medir indicadores do desenvolvimento infantil em países de baixa e média renda. As etapas do estudo contemplaram: elaboração de um inventário de itens para avaliação do desenvolvimento infantil, com base em instrumentos de livre acesso; validação de conteúdo por um grupo de especialistas no tema, com técnicas de consenso; seleção de questões para descrever as crianças e suas famílias; pré-teste do instrumento durante a campanha de vacinação de 2016 em três municípios e realização de entrevistas cognitivas. Resultados: Foram enviados 431 itens para avaliação dos especialistas, 77 foram excluídos e os demais apreciados presencialmente pelo grupo. No fim foram selecionados 162 itens que abrangeram os domínios motor, cognitivo, de linguagem e socioemocional, distribuídos em 10 faixas etárias. Foram incluídas questões sobre saúde, nutrição, aprendizagem precoce, proteção e segurança e cuidado responsivo. O instrumento foi aplicado por universitários voluntários a 367 mães de crianças menores de cinco anos, mostrou boa adesão dos cuidadores. O tempo médio de aplicação do questionário foi 20 minutos. As entrevistas cognitivas permitiram ajustar 19 itens do instrumento para melhor compreensão dos cuidadores. Conclusões: O instrumento construído e validado por especialistas preenche uma lacuna, que permite uma avaliação abrangente do desenvolvimento de crianças menores de cinco anos, em nível populacional, de forma rápida e barata, pode ser útil para o monitoramento de indicadores do desenvolvimento em campanhas de vacinação.

Validation of a tool to evaluate women's satisfaction with breastfeeding for the Brazilian population / Validação de instrumento para avaliação da satisfação da mulher com a amamentaçãopara a população brasileira

Abstract Objective To perform the construct validity and the internal consistency of the Maternal Breastfeeding Evaluation Scale tool, aiming at its application in the Brazilian population. Methods Cross-sectional study that applied the tool to 287 Brazilian women 30 days after childbirth. Main component analysis with varimax rotation was used for the factor analysis, verifying the number of subscales and the maintenance or extraction of the components. Four hypotheses were tested using the unpaired Student's t-test for construct validation. The reliability analysis was performed using Cronbach's alpha coefficient. Results The exploratory factor analysis identified the need to exclude an item and to reformulate the subscales. The results of the construct validity showed that all hypotheses proposed were confirmed: women who were breastfeeding, those who were exclusively breastfeeding, those who did not have problems related to breastfeeding, and those who intended to breastfeed for at least 12 months achieved significantly higher mean values in the scale. The tool showed adequate internal consistency (Cronbach's alpha = 0.88, 95% CI: 0.86-0.90), as did the pleasure and fulfillment of the maternal role subscales (0.92, 95% CI: 0.91-0.93%); child growth, development, and satisfaction (0.70; 95% CI: 0.65-0.75); and maternal physical, social, and emotional aspects (0.75, 95% CI: 0.70-0.79). Conclusions The validation process of the Brazilian version of the Maternal Breastfeeding Evaluation Scale tool showed that it is valid and reliable tool to be applied to the Brazilian population.

Resumo Objetivo Realizar a validação de constructo e avaliar a consistência interna do instrumento Maternal Breastfeeding Evaluation Scale, visando à sua aplicação na população brasileira. Métodos Estudo transversal com aplicação do instrumento a 287 mulheres brasileiras após 30 dias do nascimento da criança. Para a análise fatorial utilizou-se a análise de componentes principais com rotação varimax, verificando o número de subescalas e a manutenção ou extração dos componentes. Para a validação de constructo quatro hipóteses foram testadas pelo teste T-student não pareado. A análise de confiabilidade foi realizada utilizando o coeficiente de alfa de Cronbach. Resultados A análise fatorial exploratória identificou a necessidade de exclusão de um item e a reformulação das subescalas. Os resultados da validade de constructo mostraram que todas as hipóteses propostas foram confirmadas: as mulheres que estavam amamentando, as que estavam em amamentação exclusiva, as que não apresentavam problemas relacionados à amamentação e aquelas com intenção de amamentar por pelo menos 12 meses apresentaram valores médios significativamente superiores na escala. O instrumento apresentou consistência interna adequada (alfa de Cronbach = 0,88; IC95%: 0,86-0,90), assim como as subescalas prazer e realização do papel materno (0,92; IC95%: 0,91-0,93), crescimento, desenvolvimento e satisfação infantil (0,70; IC95%: 0,65-0,75) e aspectos físico, social e emocional materno (0,75; IC95%: 0,70-0,79). Conclusões O processo de validação do instrumento Maternal Breastfeeding Evaluation Scale/BRASIL constatou que ele é válido e confiável para ser aplicado à população brasileira.

Couples' relationships and breastfeeding: is there an association?

One hundred fifty-three Brazilian families with 4-month-old infants--51 cases (breastfeeding had ceased) and 102 controls (breastfeeding maintained)--were recruited to verify if a problematic couple relationship is associated with early breastfeeding termination. The relationships of the 118 cohabiting couples were assessed by clinical interviews and the Global Assessment of Relational Functioning and Beavers-Timberlawn scales, examining marital and parental functions, parents' satisfaction with the quality of care each partner provided to their infants, mothers' opinions of paternal breastfeeding support, and interviewers' assessments of paternal breastfeeding support and involvement in the infants' care. The quality of a couple relationship was not associated with the interruption of breastfeeding before 4 months postpartum. However, a good couple relationship was associated with more paternal breastfeeding support (P < .01) and involvement in the infant's care (P < .0001).

The impact of breast reduction surgery on breastfeeding performance.

The impact of reduction mammoplasty surgery on breastfeeding performance was measured comparing a group of 49 Brazilian women who had undergone breast reduction surgery using transposition techniques with 96 controls. As determined by survival analysis, the women who underwent reduction mammoplasty had a significantly shorter time of breastfeeding duration. The prevalence of exclusive breastfeeding at 1 and 4 months was 21% and 4%, respectively, for women with surgery, and 70% and 22%, respectively, for controls (P < .001). The prevalence of any breastfeeding at 1, 6, and 12 months was 58%, 16%, and 10% for women with mammoplasty, and 94%, 58%, and 42% for controls (P < .001). For women with surgery, the median duration of exclusive and any breastfeeding was 5 days and 2 months, respectively, and 3 months and 6 months for controls. The results of this study suggest that breast reduction surgery may have a negative impact on breastfeeding performance.