Nipple shield use in the maternity ward increases risk of exclusive breastfeeding interruption in the first six months of infant's life.

OBJECTIVE: The objective of this study was to investigate the association between use of silicone nipple shields in the maternity ward and exclusive breastfeeding interruption in the first 6 months of the infant's life. DESIGN: Cohort study. SETTING: Interviews were conducted personally at the mother's home at 1 and 6 months postpartum and by telephone at 2 and 4 months. PARTICIPANTS: 287 mother-infant dyads. METHODS: Lactating mothers were randomly selected at two maternity wards (one public, one private) in Porto Alegre, Brazil. Data were analyzed using Kaplan-Meier survival curves and Cox multivariate regression. The outcome of interest was exclusive breastfeeding interruption before 6 months of the infant's life. FINDINGS: Nipple shields were used by 6.2 % of the women in the public maternity ward and by 25.8 % of those in the private setting. Median duration of exclusive breastfeeding was 11 days (95 %CI 0.0-36.9) among women who used the accessory vs. 89 days (95 %CI 60.8-117.2) among those who did not. Nipple shield use in the maternity ward was associated with exclusive breastfeeding interruption before 6 months of infant's life (adjusted risk ratio = 1.47; 95 %CI 1.01-2.15). The risk was higher in the first months of breastfeeding, ranging from 2.0 to 1.47 in the first and sixth months, respectively. CONCLUSIONS: The use of silicone nipple shields in the maternity ward increased the risk of exclusive breastfeeding interruption before 6 months of the infant's life, especially in the first months. These findings suggest caution in recommending this accessory to new mothers.

Exclusive breastfeeding changes in Brazil attributable to pacifier use.

BACKGROUND: Identifying key interventions to increase exclusive breastfeeding duration has been a challenge. Pacifier use has been associated with exclusive breastfeeding discontinuation in Brazil. However, the proportion of the improvement in exclusive breastfeeding duration attributable to pacifier use remains unknown. RESEARCH AIM: Quantify the proportion of increases in exclusive breastfeeding prevalence that can be attributed to reduced pacifier use over time. METHODS: Secondary data analyses of two nationally representative cross-sectional surveys conducted in States' capitals in 1999 and in 2008 (N = 42,395 Brazilian infants under 6 months of age). We estimated the fraction of exclusive breastfeeding prevalence improvements that could be attributed to pacifier use based on multilevel regression analysis. RESULTS: From 1999 to 2008, there was an increase of 15.2 percentage points in exclusive breastfeeding prevalence and a decrease of approximately 17 percentage points in the prevalence of pacifier use among infants under 6 months. Reduction in pacifier use explained an increase in 5.5 percentage points' exclusive breastfeeding rates. If pacifier use were to decrease from 41.6% (prevalence in 2008) to 14% (as found in New Zealand), there would be an expected additional increase in exclusive breastfeeding of approximately 12 percentage points. CONCLUSIONS: About one-third of the improvements in EBF prevalence observed in Brazil over a decade can be attributed to the corresponding decline in pacifier use.

The Effect of a Pro-Breastfeeding and Healthy Complementary Feeding Intervention Targeting Adolescent Mothers and Grandmothers on Growth and Prevalence of Overweight of Preschool Children.

INTRODUCTION: The pattern and duration of breastfeeding (BF) and the age at onset of complementary feeding, as well as its quality, have been associated with the prevalence of overweight in childhood. OBJECTIVE: To assess the effect of a pro-BF and healthy complementary feeding intervention, targeted to adolescent mothers and maternal grandmothers, on growth and prevalence of overweight and obesity in children at preschool age. This intervention had a positive impact on duration of BF and timing of onset of complementary feeding. METHODS: This randomized clinical trial involved 323 adolescent mothers, their infants, and the infants' maternal grandmothers, when they cohabited. Mothers and grandmothers in the intervention group received counseling sessions on BF and healthy complementary feeding at the maternity ward and at home (7, 15, 30, 60, and 120 days after delivery). When children were aged 4 to 7 years, they underwent anthropometric assessment and collection of data on dietary habits. Multivariable Poisson regression with robust estimation was used for analysis. RESULTS: BMI-for-age and height-for-age were similar in the intervention and control groups, as was the prevalence of overweight (39% vs. 31% respectively; p=0.318). There were no significant between-group differences in dietary habits. CONCLUSION: Although the intervention prolonged the duration of exclusive BF and delayed the onset of complementary feeding, it had no impact on growth or prevalence of overweight at age 4 to 7 years. TRIAL REGISTRATION: ClinicalTrials.gov NCT00910377.

Counselling sessions increased duration of exclusive breastfeeding: a randomized clinical trial with adolescent mothers and grandmothers.

BACKGROUND: Considering that adolescent mothers may be more vulnerable to discontinuing exclusive breastfeeding (EBF) before 6 months and that their mothers may exert a negative influence on this practice, this study was conducted with the objective of evaluating the efficacy of breastfeeding counselling for adolescent mothers and their mothers in increasing EBF duration. METHODS: A clinical trial was performed in 323 adolescent mothers with newborns and their mothers randomized in four groups: (1) not living with mother, without intervention; (2) not living with mother, with intervention; (3) living with mother, without intervention, (4) living with mother, with intervention. The intervention consisted of five counselling sessions directed to mother and grandmother, in the maternity hospital and on follow-up. Information about feeding practices during the newborn's first six months of life was collected monthly by telephone. Intervention's efficacy was measured through Cox regression and comparison of exclusive breastfeeding medians and survival curves for the different groups. RESULTS: The intervention increased the duration of EBF by67 days for the group which included grandmothers (HR = 0.64; CI 95% = 0.46-0.90) and 46 days for the group which did not include grandmothers (HR = 0.52; CI 95% = 0.36-0.76). CONCLUSIONS: Counselling sessions in the first four months of children's lives proved to be effective in increasing EBF duration among adolescent mothers. TRIAL REGISTRATION: ClinicalTrials.gov NCT00910377.

Duration of breastfeeding and distoclusion in the deciduous dentition.

OBJECTIVE: This study investigated the association between duration of breastfeeding and occurrence of distoclusion in preschoolers with complete deciduous dentition. SUBJECTS AND METHODS: A cross-sectional study nested within a cohort of 153 Brazilian children was conducted. The outcome of interest was presence of distoclusion as diagnosed at dental assessment between 3 and 5 years of age. Data on the main exploratory variable (duration of breastfeeding) and other variables that might influence the study outcome (use of dummy/pacifier, bottle feeding, and thumb sucking) were collected by a blinded examiner at 7, 30, 60, 120, and 180 days of life and at dental assessment. Poisson regression was used to test for the association between exposure and the outcome of interest. RESULTS: The prevalence of distoclusion was 47.7%. Multivariate analysis showed that breastfeeding afforded some protection against distoclusion, after adjusting for confounding factors such as pacifier use and bottle feeding. In children breastfed for 12 months or more, the prevalence of distoclusion at 3-5 years of age was 56% lower than in those breastfed for shorter periods (prevalence ratio=0.44; 95% confidence interval 0.23-0.82). CONCLUSION: Breastfeeding for 12 months or longer significantly reduces the prevalence of distoclusion in the deciduous dentition.