Association between pacifier use and bottle-feeding and unfavorable behaviors during breastfeeding / Associação entre uso de chupeta e mamadeira e comportamentos desfavoráveis à amamentação durante as mamadas

Abstract Objective: To investigate the association between pacifier use and bottle-feeding and unfavorable behaviors during breastfeeding. Method: A cross-sectional study was conducted with 427 babies/mothers. Socio-demographic, perinatal data, and information about the use of artificial nipples (pacifier and/or bottle) were collected through a questionnaire. The breastfeeding aspects regarding position, affectivity, sucking behavior, baby responses, and breast anatomy were evaluated through observation during breastfeeding. The chi-squared test and the multiple linear regression analysis were used to investigate the association between the variables. Results: The aspects of breastfeeding that showed higher percentages of the category "poor" were sucking behavior (22.5%) and position (22.2%). The group of infants who used pacifiers and/or bottle showed higher percentages in the poor and fair categories when compared with the good category for all five breastfeeding aspects evaluated (p < 0.001). The linear regression analysis revealed that the increase in the number of unfavorable behaviors regarding position, affectivity, sucking behavior, and baby responses were independently associated with both pacifier and bottle use (β positive, p < 0.05), while breast anatomy was independently associated only with bottle use. Conclusion: The findings suggest that the use of pacifiers and/or bottle-feeding may be associated with unfavorable behaviors during breastfeeding, especially the use of bottle-feeding.

Resumo Objetivo: Investigar a associação entre uso de chupeta e mamadeira e comportamentos desfavoráveis à amamentação durante as mamadas. Métodos: Um estudo transversal foi conduzido com 427 bebês/mães. Foram coletados dados sociodemográficos, perinatais e sobre o uso de bicos artificiais (chupeta e/ou mamadeira) através de questionário. Os aspectos de amamentação referentes à posição, afetividade, adequação da sucção, respostas do bebê e anatomia das mamas foram avaliados através da observação durante a mamada. O teste qui-quadrado e a análise de regressão linear múltipla foram usados para investigar associação entre as variáveis. Resultados: Os aspectos de amamentação que apresentaram percentuais mais elevados da categoria ruim foram a adequação da sucção (22,5%) e posição (22,2%). O grupo de bebês que usavam chupeta e/ou mamadeira apresentou percentuais mais elevados nas categorias ruim e regular quando comparados com a categoria bom para todos os cinco aspectos da amamentação avaliados (p < 0,001). A análise de regressão linear revelou que o incremento do número de comportamentos desfavoráveis referentes à posição, afetividade, adequação da sucção e respostas do bebê estavam associados de forma independente tanto ao uso de chupeta quanto ao uso de mamadeira (β positivo, p < 0,05), enquanto que anatomia das mamas estava associado de forma independente apenas com o uso de mamadeira. Conclusão: Os achados sugerem que o uso de chupeta e/ou mamadeira pode estar associado a comportamentos desfavoráveis durante amamentação, em especial o uso de mamadeira.

Randomised controlled trial of a theory-based behavioural intervention to reduce formula milk intake.

OBJECTIVE: To assess the efficacy of a theory-based behavioural intervention to prevent rapid weight gain in formula milk-fed infants. DESIGN: In this single (assessor) blind, randomised controlled trial, 669 healthy full-term infants receiving formula milk within 14 weeks of birth were individually randomised to intervention (n=340) or attention-matched control (n=329) groups. The intervention aimed to reduce formula milk intakes, and promote responsive feeding and growth monitoring to prevent rapid weight gain (≥+0.67 SD scores (SDS)). It was delivered to mothers by trained facilitators up to infant age 6 months through three face-to-face contacts, two telephone contacts and written materials. RESULTS: Retention was 93% (622) at 6 months, 88% (586) at 12 months and 94% attended ≥4/5 sessions. The intervention strengthened maternal attitudes to following infant feeding recommendations, reduced reported milk intakes at ages 3 (-14%; intervention vs control infants), 4 (-12%), 5 (-9%) and 6 (-7%) months, slowed initial infant weight gain from baseline to 6 months (mean change 0.32 vs 0.42 SDS, baseline-adjusted difference (intervention vs control) -0.08 (95% CI -0.17 to -0.004) SDS), but had no effect on the primary outcome of weight gain to 12 months (baseline-adjusted difference -0.04 (-0.17, 0.10) SDS). By 12 months, 40.3% of infants in the intervention group and 45.9% in the control group showed rapid weight gain (OR 0.84, 95% CI 0.59 to 1.17). CONCLUSIONS: Despite reducing milk intakes and initial weight gain, the intervention did not alter the high prevalence of rapid weight gain to age 12 months suggesting the need for sustained intervention. TRIAL REGISTRATION NUMBER: ISRCTN20814693.

Association between pacifier use and bottle-feeding and unfavorable behaviors during breastfeeding.

OBJECTIVE: To investigate the association between pacifier use and bottle-feeding and unfavorable behaviors during breastfeeding. METHOD: A cross-sectional study was conducted with 427 babies/mothers. Socio-demographic, perinatal data, and information about the use of artificial nipples (pacifier and/or bottle) were collected through a questionnaire. The breastfeeding aspects regarding position, affectivity, sucking behavior, baby responses, and breast anatomy were evaluated through observation during breastfeeding. The chi-squared test and the multiple linear regression analysis were used to investigate the association between the variables. RESULTS: The aspects of breastfeeding that showed higher percentages of the category "poor" were sucking behavior (22.5%) and position (22.2%). The group of infants who used pacifiers and/or bottle showed higher percentages in the poor and fair categories when compared with the good category for all five breastfeeding aspects evaluated (p<0.001). The linear regression analysis revealed that the increase in the number of unfavorable behaviors regarding position, affectivity, sucking behavior, and baby responses were independently associated with both pacifier and bottle use (ß positive, p<0.05), while breast anatomy was independently associated only with bottle use. CONCLUSION: The findings suggest that the use of pacifiers and/or bottle-feeding may be associated with unfavorable behaviors during breastfeeding, especially the use of bottle-feeding.

Predictors of Readiness for Hospital Discharge After Birth: Building Evidence for Practice.

BACKGROUND: Preparation for hospital discharge after birth became a global concern when hospitals in many developing countries began implementing shorter lengths of stay for uncomplicated deliveries. A mother's perceived readiness for hospital discharge may be influenced by many factors that can ultimately shape postdischarge outcomes. AIMS: The purpose of this study was to explore the antepartum, intrapartum, and postpartum predictors of discharge readiness, including nursing educational practices that are predictive of postpartum mothers' perceptions of readiness for hospital discharge. METHODS: The Adaptation to Transitions conceptual framework guided the descriptive correlational study design and measures. A purposive sample of 185 English- and Spanish-speaking postpartum mothers who experienced an uneventful vaginal or cesarean birth of a healthy infant completed demographic, quality of discharge teaching, and readiness for hospital discharge questionnaires prior to discharge. RESULTS: Mothers with three or more children, delivery mode, bottle-feeding, the delivery of education, and the difference between educational content received and needed, were significant predictors that accounted for 42% of the variance in readiness for hospital discharge (R2 = 0.42, F[10,174] = 14.52, p < .001). Nurses' skill in teaching and educational content received were significant predictors even with parity, feeding, and delivery mode in the model. LINKING EVIDENCE TO ACTION: The relationship between quality of discharge teaching and discharge readiness provides evidence of the critical role nurses have in the discharge preparation process. Nurse education programs and evidence-based guidelines should be designed to enhance patient education focused on the adequacy and delivery of teaching content.

Factors Associated with Infant Feeding Choices in the Adolescent Population.

BACKGROUND: Strong recommendations have been made for exclusive breastfeeding of infants for the first 6 months of life, with continuation throughout the first year. In an attempt to optimize support for breastfeeding, particular barriers in populations with decreased rates need to be analyzed. OBJECTIVE: This study aimed to determine if participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food voucher program, involvement of the infant's father, involvement of the adolescent mother's parents or other caregivers, and participation in early skin-to-skin contact after birth are associated with the decision to breastfeed or bottle feed among this adolescent population. METHODS: A retrospective chart review of 457 adolescent patients who delivered January 2010 through May 2013 at the University of Louisville Hospital was conducted. Nursing documentation was used to determine the patient's intention to breastfeed or bottle feed, participation in WIC, involvement of the infant's father, involvement of the patient's parents, and participation in early skin-to-skin contact after delivery. These factors were compared using Fisher exact test. RESULTS: Three hundred one adolescents reported a plan to breastfeed (65.9%) and 156 reported a plan to bottle feed (34.1%) when questioned pre-delivery. There was no significant difference between the groups with respect to WIC participation or involvement of the infant's father. The bottle-feeding group had a significantly higher percentage who reported parental involvement (80.1% vs 67.8%, P = .0059). The breastfeeding group had a significantly higher percentage who participated in early skin-to-skin contact after birth (74.5% vs 58.1%, P = .0064). CONCLUSION: Involvement of the adolescent mothers' parents or caregivers was associated with the decision to bottle feed. Participation in early skin-to-skin contact after birth was associated with the decision to breastfeed.

Factors affecting the demarketing of breastmilk substitutes in Palestine.

BACKGROUND: Although medical research has proven that breastfeeding is unparalleled in providing the ideal nutrition for infants, "the demarketing of breastmilk substitutes" is a little-known concept. This empirical study tackled the origin and definition of demarketing, examined the different factors affecting the demarketing of breastmilk substitutes in Palestine from the breastfeeding woman's point of view, and developed an appropriate model for the demarketing of breastmilk substitutes. The article subsequently concludes with recommendations for areas of further academic research in the World Health Assembly, for policy makers in Palestine, and for the breastfeeding women themselves. SUBJECTS AND METHODS: An empirical study was conducted to collect the primary data using a questionnaire as a tool in order to test the hypotheses. The questionnaire was distributed to 400 breastfeeding women who were randomly selected from the population. RESULTS: The findings proved that there is a relationship between independent variables (i.e., product, price, place, and promotion) and the dependent variable (i.e., demarketing of breastmilk substitutes) based on several reasons discussed thoroughly in this article. CONCLUSIONS: Product, price, place, and promotion affect the demarketing of breastmilk substitutes in Palestine.

[Early childhood caries and associated risk factors among infants in the German federal state of Brandenburg]. / Frühkindliche Karies und assoziierte Risikofaktoren bei Kleinkindern im Land Brandenburg.

The objective of this study was to determine the caries experience in a representative sample of infants aged 13-36 months in the federal state of Brandenburg in relation to their parents' health behavior and social status. Calibrated public health service dentists examined 661 children in ten districts according to WHO standards (1997). Data on the parents' health behavior and their social status were acquired via questionnaire. The prevalence of caries was 7.4% on enamel-level (d1-4) and 5.3% on dentin-level (d3-4). The caries experience was 0.3 d1-4mft/0.2 d3-4mft. Fifty-two percent of the total caries burden was concentrated on 2% of the children. The restorative index was 19.9% and the care index 10%, respectively. Children of 25-36 months of age and with a lower social status and those who were bottle-fed at night revealed a significantly higher caries risk (OR 3.84, p = 0.005; OR 7.34, p < 0.0001; OR 2.4, p = 0.022) compared to younger children, children with a higher social status, or those without nocturnal bottle use. Intersectoral prevention programs in day-care centers are the favored preventive approach to compensate the socially determined health inequality. The low care index needs to be communicated with the dental association to improve the accessibility of infants in dental practice.

Marketing breast milk substitutes: problems and perils throughout the world.

On 21 May 1981 the WHO International Code of Marketing Breast Milk Substitutes (hereafter referred to as the Code) was passed by 118 votes to 1, the US casting the sole negative vote. The Code arose out of concern that the dramatic increase in mortality, malnutrition and diarrhoea in very young infants in the developing world was associated with aggressive marketing of formula. The Code prohibited any advertising of baby formula, bottles or teats and gifts to mothers or 'bribery' of health workers. Despite successes, it has been weakened over the years by the seemingly inexhaustible resources of the global pharmaceutical industry. This article reviews the long and tortuous history of the Code through the Convention on the Rights of the Child, the HIV pandemic and the rare instances when substitute feeding is clearly essential. Currently, suboptimal breastfeeding is associated with over a million deaths each year and 10% of the global disease burden in children. All health workers need to recognise inappropriate advertising of formula, to report violations of the Code and to support efforts to promote breastfeeding: the most effective way of preventing child mortality throughout the world.

A longitudinal study of dental caries risk among very young low SES children.

OBJECTIVES: Early childhood caries (ECC) is a challenging public health problem in the United States and elsewhere; however, there is limited information concerning risk factors in very young children. The purpose of this study was to assess baseline risk factors for 18-month caries prevalence as part of a longitudinal study of high-risk children. METHODS: About 212 children, 6-24 months of age were recruited from a rural community in Iowa. Subjects were enrolled in the WIC program, which provides nutritional support for low-income families with children. Dental examinations using d1, d2-3 criteria were conducted at baseline and after 18 months. Caries prevalence was determined at the frank decay level (d2-3 or filled surfaces), as well as at the noncavitated level (d1), and combined (d1, d2-3 or f surfaces). Risk factor data were collected at baseline and after 9- and 18- months. These data included beverage consumption data, presence of visible plaque, and use of fluoride toothpaste for children as well as mutans streptococci (MS) levels of mothers and children and family sociodemographic factors. RESULTS: About 128 children (60%) remained in the study after 18 months. Among these children, prevalence of d1,d2-3/f level caries increased from 9% to 77%, while d2-3/f level caries increased from 2% to 20%. Logistic regression models for baseline predictors of d2-3f caries at the 18-month follow-up found the presence of MS in children (OR=4.4; 95% CI: 1.4, 13.9) and sugar-sweetened beverages (OR=3.0; 95% CI: 1.1, 8.6) to be the only significant risk factors. Sociodemographic factors and the use of fluoride toothpaste were not significant in these models. CONCLUSIONS: Results suggest that early colonization by MS and consumption of sugar-sweetened beverages are significant predictors of ECC in high-risk populations.

[Prevalence and factors associated with non-nutritive sucking behavior. Cross sectional study among 5- to 6-year-old Senegalese children]. / Prévalence et facteurs associés aux habitudes de succion non nutritive. Etude transversale chez des enfants sénégalais âgés de 5/6 ans.

Sucking behaviours have been described in the literature under two facets i.e. nutritive and non nutritive. Nutritive sucking refers to breast feeding, bottle feeding or a combination of both. Non nutritive sucking habits are mentioned when children suck their thumb or another finger(s), a pacifier or any other object. Non nutritive sucking habits (NNSH) are suspected to potentially induce dentoalveolar anomalies and thus may constitute a public dental health problem. Anthropological and historical data suggest that non nutritive sucking habits are associated with modern pattern of life. The aim of this study is to investigate the prevalence and factors associated with NNSH in Senegalese children 5/6 years old. Data of this study were collected using a structured questionnaire administered by the investigators to mothers or caregivers of 443 children (231 boys and 212 girls) aged 5/6 years. Three types of data were collected: data on the social background of the children including place of residence (urban, suburban and rural) and the mother's occupation (workers, employee, executive, housewife), data regarding former and present sucking habits and information on the feeding pattern of the children when they were infants (breast feeding, bottle feeding or a combination of both). The results indicated a prevalence rate of 16.50% and 17.20% respectively for digit and pacifier sucking in this population. Also, a significant association was found between children's non nutritive sucking habits in one hand and the mothers' occupation and feeding pattern on the other hand. Breast fed children are less prone to develop a non nutritive sucking habit than bottle fed children. Longitudinal studies are necessary to verify the nature of these associations. The identification of factors associated with non nutritive sucking habits would permit to develop and target recommendations for the prevention of such habits.

Risk factors for early childhood caries in Canadian preschool children seeking care.

PURPOSE: The purpose of this study was to determine family characteristics, beliefs, and habits that contribute to early and severe caries in young children in Canada. METHODS: A survey was administered to: (1) parents of 139 children diagnosed with early childhood caries (ECC) in 5 pediatric dentistry practices in Canada over a 33-month period (group 1); and (2) parents of all normal referrals (carious and noncarious children) in one of the practices over a 3 month period (group 2). Group 2 prevented studying an exclusive or polarized population, and allowed direct comparison between children with decoy and without decoy. The survey responses were compared with caries rates in the children, determined by dental examination, to detect important correlations of family and child factors with the disease level. Chi-square and logistic regression analyses described the strength of the relationships. RESULTS: Parent responses provided information on: (1) demographics; (2) economic status; (3) birth order; (4) parental education; (5) payment methods; (6) feeding and weaning history; (7) fluoride history; (8) food habits; (9) hygiene; (10) behavior; and (11) medication use. Caries presence and severe caries was linked to: (1) leaving the bottle with a child while sleeping; (2) having problems brushing a child's teeth; (3) prolonged holding of liquids in the mouth; and (4) being Caucasian. The authors did find that bottle use in general and having a difficult child were protective influences against decay. CONCLUSIONS: The factors providing the most caries risk are: (1) being left with a bottle while sleeping; (2) parents having problems brushing the child's teeth; (3) holding liquids in the mouth for prolonged times; and (4) ethnicity.

Determinants of bottle use amongst economically disadvantaged mothers.

BACKGROUND: There is documented evidence of increased risk of infant mortality in formula fed infants versus breast fed babies. The hazards of bottle use for infant feeding, especially in underprivileged communities, are also well known. As the issue of bottle use is directly related to childhood survival and mortality, there is legislation against propagation of bottle-feeding in Pakistan. OBJECTIVES: To obtain information about determinants of bottle use for infant feeding in a low-income periurban community. DESIGN: Community based cross-sectional study. RESULTS: 150 mothers with infants up to one year of age were included in the study period from October 03 to March 04. Out of these 102 mothers were found using bottle for infant with or without breast-feeding. The tendency to use the bottle increased in relation to child's increasing age. Only 17% of the infants under the age of 3 months were offered bottle, it was 69% between 4 to 6 months and it increased to 76% in infants from 7 months to 1 year. The attributes associated with increased bottle use were mother's older age, illiteracy and increased parity. CONCLUSION: Bottle use is a public health issue in poor and illiterate mothers of developing countries. While, in Pakistan, laws are enacted against its propagation, we need community-based strategies to bring about a socio-cultural shift in the growing prevalence of bottle use found in the study.

Dietary exposure assessment of infants to bisphenol A from the use of polycarbonate baby milk bottles.

The residual bisphenol A (BPA) levels in 28 different brands of polycarbonate (PC) baby milk bottles available in the Singapore market were measured. With a detection limit of 3 mg/kg, BPA residues were detected in 19 out of the 28 PC baby milk bottles at levels between 4.01 and 141 mg/kg, with a mean of 28.1 +/- 31.4 mg/kg and a median of 17.2 mg/kg. The potential migration of BPA from each of the 28 PC milk bottles was also measured using food-simulating solvents and time conditions recommended by the US Food and Drug Administration (US FDA), but using temperatures more severe than actual use. The highest upper-bound mean BPA migration levels of 0.64 +/- 0.48 microg/in2 in 10% ethanol at 70 degrees C and 0.43 +/- 1.25 microg/in2 in corn oil at 100 degrees C were observed after incubating cut portions of the milk bottles for 240 h. With this migration data and using US FDA's procedure for estimation of dietary exposure, the worst-case dietary exposure assessment for the intake of BPA by infants between birth and three months of age was below the oral Reference Dose of 0.05 mg/kg bw/day established by the US Environmental Protection Agency. This study showed that the dietary exposure to BPA from actual uses of PC milk bottles is unlikely to pose a health risk in infants.

Social and behavioural determinants of early childhood caries.

BACKGROUND: To investigate the association between selected social and behavioural (infant feeding and preventive dental practices) variables and the presence of early childhood caries in preschool children within the north Brisbane region. METHODS: A cross sectional sample of 2515 children aged four to five years were examined in a preschool setting using prevalence (percentage with caries) and severity (dmft) indices. A self-administered questionnaire obtained information regarding selected social and behavioural variables. The data were modelled using multiple logistic regression analysis at the 5 per cent level of significance. RESULTS: The final explanatory model for caries presence in four to five year old children included the variables breast feeding from three to six months of age (OR=0.7, CI=0.5, 1.0), sleeping with the bottle (OR=1.9, CI=1.5, 2.4), sipping from the bottle (OR=1.6, CI=1.2, 2.0), ethnicity other than Caucasian (OR=1.9, CI=1.4, 2.5), annual family income dollars 20,000-dollars 35,000 (OR=1.7, CI=1.3, 2.3) and annual family income less than dollars 20,000 (OR=2.1, CI=1.5, 2.8). CONCLUSIONS: A statistical model for early childhood caries in preschool children within the north Brisbane region has been constructed using selected social and behavioural determinants. Epidemiological data can be used for improved public oral health service planning and resource allocation within the region.

Preschool caries as an indicator of future caries: a longitudinal study.

PURPOSE: This study was performed to compare the increment of carious surfaces per year in preschool-age children with early childhood caries (ECC), children with posterior caries only, and caries-free children after 7 to 10 years. METHODS: One hundred and fifty files of children were included in the study. The first examination referred to the ages of 3 to 5 years (T1), and follow-up visits took place after at least 7 years (T2). The number of carious surfaces was recorded. The study population was divided into 3 groups: (1) caries free children (CF), (2) children with ECC, and (3) children with posterior caries only (PC). There were 50 patients in each group. RESULTS: Children with ECC had 1.15+/-0.97 new affected surfaces per year, while caries-free children had an increment per year of 0.41+/-0.60, and children with posterior caries only showed an increment per year of 0.74+/-0.64. A statistically significant difference was found between the ECC and caries-free groups, and between the ECC and posterior caries groups. The high increment in the ECC group is influenced by the high number of affected surfaces in the primary teeth, CONCLUSIONS: Children with ECC may have a high risk to develop future carious lesions compared with caries-free children. Children with posterior caries demonstrate less carious lesions by the age of 12 years, however, they resemble ECC children when they reach their mid-teens.

Causes, treatment and prevention of early childhood caries: a microbiologic perspective.

Early childhood caries (ECC) is a virulent form of dental caries that can destroy the primary dentition of toddlers and preschool children. It occurs worldwide, afflicting predominantly disadvantaged children. High-risk North American populations include Hispanic and Native American children, as well as children enrolled in Head Start, a federally funded program for preschool children living in poverty. The prevalence of EEC among these children ranges from 11% to 72%. ECC is an infectious disease, and Streptococcus mutans is the most likely causative agent; diet also plays a critical role in the acquisition and clinical expression of this infection. Early acquisition of S. mutans is a key event in the natural history of the disease. Acquisition may occur via vertical or horizontal transmission. Primary oral colonization by S. mutans coupled with caries-promoting feeding behaviours results in accumulation of these organisms to levels exceeding 30% of the total cultivable plaque flora which in turn leads to rapid demineralization of tooth structure. Treatment of ECC is costly because the cooperative capacity of babies and preschool children usually necessitates the use of general anesthesia. Treatment usually consists of restoration or surgical removal of carious teeth along with recommendations regarding feeding habits. However, this approach has resulted in unacceptable clinical outcomes, and relapse rates of approximately 40% have been reported within the first year after dental surgery. Primary prevention of ECC has largely been restricted to counselling parents about caries-promoting feeding behaviours. This approach has also had minimal success. Newer strategies addressing the infectious component through use of topical antimicrobial therapy appear promising.

Early childhood caries-related visits to hospitals for ambulatory surgery in New York State.

OBJECTIVES: The objective of this study was to assess the utilization of ambulatory surgery at hospitals for the treatment of early childhood caries in New York State. METHODS: Data for this study came from the Statewide Planning and Research Cooperative System in New York State. We analyzed 16,149 oral health-related ambulatory surgeries performed between 1996 and 1999 in children younger than 6 years of age. RESULTS: Between 1996 and 1999, the rate of hospitalization for dental caries in children younger than 6 years of age ranged from 180 to 193 cases per 100,000. Approximately two-thirds of the visits by children younger than 6 years old were due to dental caries. The highest rate was observed in 3-year-old children (346.5). The most frequent type of procedure performed was placement of stainless steel crowns. Medicaid was the primary source of reimbursement. CONCLUSIONS: These data illustrate that, although dental caries is preventable, it continues to be a significant problem in young children and results in a large number of ambulatory surgery visits.

Caries prevalence and patterns and their relationship to social class, infant feeding and oral hygiene in 4-5-year-old children in Amman, Jordan.

OBJECTIVES: To investigate the relationship between social class, infant feeding, oral hygiene, and prevalence and patterns of caries in 4-5-year-old Jordanian children. METHOD: Two-stage random sampling procedure was used to select children enrolled in kindergartens in Amman, Jordan. Clinical examinations were carried out by one examiner. Mothers completed questionnaires relating to social class, infant feeding and the oral hygiene habits of the children. RESULTS: Sixty-seven per cent of the children had caries; 30% had the more extensive pattern involving molars and incisors. When the significant variables were taken into account, age, social class, sleeping with the mother, use of comforter and confectionery at bed/night time were shown to be independent risk factors for caries experience. Bottle-feeding at nap/bed/night time was associated with caries in incisors and caries in incisors and/or canines. Never being breast-fed, being breast-fed for more than 18 months, being breast-fed at nap/bed/night time showed a negative association with caries confined to molars although this showed a positive association with the more extensive pattern of the disease. CONCLUSIONS: Education for mothers about appropriate breast and bottle-feeding practices should be considered in health promotion strategies.