Early feeding practices and severe early childhood caries in four-year-old children from southern Brazil: a birth cohort study.

The aim of this study was to investigate the relationship between feeding practices in the first year of life and the occurrence of severe early childhood caries (S-ECC) at 4 years of age. A birth cohort study (n = 500) was conducted in children who were born within the public health system in São Leopoldo, Brazil. Feeding practices were assessed using standardized methods at 6 and 12 months of age. A total of 340 children were examined at 4 years of age. S-ECC was defined as recommended by an expert panel for research purposes: ≥1 cavitated, missing or filled smooth surfaces in primary maxillary anterior teeth or d(1+) mfs ≥5. Poisson regression with robust variance was used in order to determine the early feeding practices which represent risk factors for the occurrence of S-ECC at 4 years of age. The multivariable model showed a higher adjusted risk of S-ECC for the following dietary practices at 12 months: breastfeeding ≥7 times daily (RR = 1.97; 95% CI = 1.45-2.68), high density of sugar (RR = 1.43; 95% CI = 1.08-1.89), bottle use for liquids other than milk (RR = 1.41; 95% CI = 1.08-1.86), as well as number of meals and snacks >8 (RR = 1.42; 95% CI = 1.02-1.97). Mother's education ≤8 years was also associated with the outcome. The present study identified early feeding practices which represent risk factors for caries severity in subsequent years. These findings may contribute to developing general and oral health interventions, with special attention to families with low maternal education.

[Evolution of breastfeeding pattern]. / Evolução do padrão de aleitamento materno.

OBJECTIVE: To follow the evolution of the breastfeeding practice among women in a childbirth clinic and evaluate the actions for its promotion. METHODS: Two cohorts of children born in an school hospital of Porto Alegre, Brazil, in different periods of time were compared regarding the prevalence of breastfeeding during the first six months of life, and the percentage of early cessation of breastfeeding. Both were prospective studies, including 202 children in the cohort of 1987, and 187 children in the cohort of 1994. All participants were healthy children, with birth weight of 2500g or more, were being breastfed and their parents were living in the same house. The 1987 study children were followed up through mail, and the 1994 study ones by home visits. RESULTS: Survival analysis showed similar frequencies of breastfeeding in the two cohorts. The prevalence of exclusive breastfeeding, although for a short period in both groups, was higher in the population studied in 1994, especially among children whose mothers were better educated. There was no rate difference of early cessation of breastfeeding between the two cohorts (36% for the 1987 cohort and 39% for the 1994 cohort). CONCLUSIONS: The results revealed a certain degree of apathy in regard of the promotion of breastfeeding during the studied period, giving support to actions to promote breastfeeding, especially among poor families.

[Risk factors for suspicion of developmental delays at 12 months of age] / Fatores de risco para suspeita de atraso no desenvolvimento neuropsicomotor aos 12 meses de vida.

OBJECTIVE: To investigate the prevalence of positive screening test for developmental delays in a cohort of children born in Pelotas, Brazil in 1993, and their risk factors. METHODOLOGY: A sample of 20% (1,363 children) of a cohort of children born in Pelotas, Brazil, was studied at 12 months of age regarding their development. The Denver II Test was used. The children who failed in two or more items of the test were suspected of having development delay. A set of independent variables was chosen taking into account the hierarchical relations between risk factors according to the conceptual framework (socioeconomic, reproductive and environmental, birth conditions, childrens care, nutrition and morbidity). Analyses were performed using Mantel-Haenszel X2 and multivariate technique through conditional logistic regression, to control for possible confounding. RESULTS: At 12 months of age, 34% (463) of the total of 1,363 children failed in the screening test. After adjusting for possible confounding variables, failure was associated with family lower income children (OR= 1.5), very low birth weight (OR= 4.0), gestational age less than 37 weeks (OR= 1.6), more than three siblings (OR= 1.9), and duration of breastfeeding less than three months (OR=1.6), or no breastfeeding (OR= 1.9). Children who presented weight/age at six months of age less or equal to -2 z score of the reference population presented a risk 10 times greater of having failure in the Denver II Test. CONCLUSIONS: This study reinforces the multiple etiology of development delays and the concept of cumulative risk effect. In this population those who are economically disadvantaged accumulate risk factors (social, economic and environmental) that may render to deficits in their development.

[Breast-feeding in clinical practice] / O aleitamento materno na prática clínica.

OBJECTIVE: To present an updated review on practical aspects of breast-feeding promotion and management. METHODS: Review of relevant publications from scientific journals, technical books and publications by international organizations. RESULTS: Nowadays, exclusive breast-feeding is recommended for a period of approximately 6 months, and maintenance of complementary breast-feeding should continue for 2 or more years. Despite abundant scientific evidence on the superiority of breastmilk over other types of milk, the number of women who breast-feed their infants according to present recommendations is still low. Health care providers can improve this scenario by encouraging breast-feeding and helping nurturing mothers to overcome breast-feeding hindrances. Therefore, health professionals must have the necessary knowledge and skills for managing the different stages of lactation. This way, they will be able to provide prenatal counseling, guidance and help during the breast-feeding initiation period, careful evaluation of breast-feeding techniques and adequate interventions in the event of any problems associated with breast-feeding. This article is concerned with some important topics related to breast-feeding in clinical practice. CONCLUSION: Breast-feeding is the ideal method for infant feeding, and it can certainly be facilitated by health care providers through adequate clinical practice.

[Complementary feeding] / Alimentação complementar.

OBJECTIVE: To present an updated review about complementary feeding in infants and children under 2 years old. METHODS: Relevant materials from scientific journals, technical books and publications by international organizations were used. The most important source of data was a publication by the World Health Organization on complementary feeding carried out in Montpellier, France, in December 1995. RESULTS: In recent years, new findings on ideal infant feeding have buried former concepts and practices. The value of exclusive breast-feeding during the first months of life and the introduction of timely and adequate complementary feeding has been acknowledged. Complementary foods are defined as any solid or liquid foods with nutritional value other than breastmilk, offered to breast-fed infants It is recommended that complementary feeding be initiated around the 6th month of life. These foods should be rich in energy, proteins and micronutrients, free from contamination, easily digestible and in adequate amount. On recommending a healthy diet, the availability, accessibility and cultural values of food should be taken into consideration. CONCLUSION: Health professionals have an important role in the improvement of infant nutrition. Those in charge of child care have to be properly advised and warned of the importance of a healthy diet for current and future health status.

Does parental breastfeeding knowledge increase breastfeeding rates?

OBJECTIVE: Although improving mothers' knowledge about breastfeeding can increase rates and duration of breastfeeding, little is known about the influence of fathers' knowledge. The purpose of this study was to assess the knowledge of mothers and fathers about breastfeeding before and after receiving postpartum advice and its relationship to the frequency of breastfeeding. METHODS: A clinical trial was performed with mothers and fathers of normal children born at the Hospital de Clínicas de Porto Alegre, Brazil, between July 1994 and March 1995. The study intervention consisted of postpartum advice supplied by means of a video film discussing basic topics of breastfeeding, an explanatory leaflet, and open discussion after viewing the video. The first 208 couples comprised the control group, the next 197 comprised experimental group 1, and the remaining 196 comprised experimental group 2. Immediately after delivery, mothers and fathers in the three groups answered a test on breastfeeding knowledge; they completed the same test at the end of the first month. All families received home visits at the end of the first, second, fourth, and sixth months, or until breastfeeding ceased. Logistic regression was used to evaluate the association between the mothers' and fathers' knowledge and frequency of breastfeeding. RESULTS: Postpartum advice increased the breastfeeding knowledge of mothers and fathers. The mothers with the highest level of knowledge had a 6.5 times higher chance of exclusively breastfeeding at the end of the third month, and 1.97 times higher chance of continuing breastfeeding to the end of the sixth month compared with other mothers. The fathers' knowledge also significantly influenced breastfeeding rates. The children whose fathers knew more had a 1.76 higher chance of being exclusively breastfed at the end of the first month, and 1.91 higher chance of receiving maternal milk at the end of the third month. CONCLUSION: A simple, inexpensive strategy can increase the level of breastfeeding knowledge of mothers and fathers and, consequently, have a positive impact on the frequency of breastfeeding.

[A simple strategy increases mother's knowledge of breastfeeding and improves the breastfeeding rates] / Uma estratégia simples que aumenta os conhecimentos das mães em aleitamento materno e melhora as taxas de amamentação.

OBJECTIVE: To assess mother's knowledge of breastfeeding before and after guidance supplied during the postpartum period and its relationship to the prevalence of breastfeeding.METHODS: A clinical trial was performed with 405 mothers of normal children born at Hospital de Clínicas de Porto Alegre from July to December 1994. The intervention consisted of guidance given by means of a video film discussing basic topics on breastfeeding, an explanatory leaflet and open discussion after the video. The first 208 mothers constituted the Control Group and the remaining 197 the Experimental Group. All mothers answered a question form for identification purposes and a test on previous knowledge regarding breastfeeding in the maternity ward. The mothers in both groups were followed by means of home visits at the end of the first, second, fourth and sixth months, or until they stopped breastfeeding. At the end of the first month the mothers were submitted to the same test given right after delivery. Logistic regression was used to evaluate the association between the mothers knowledge of breastfeeding and the prevalence of breastfeeding.RESULTS: The mothers who received the intervention (Experimental Group) had a significantly higher score in the tests on knowledge of breastfeeding at the end of the first month as compared with the mothers in the Control Group (17.0 versus 14.7). The intervention increased by 1.7 mothers chances of achieving a score above the average. The mothers whose scores were above the average had a 8.2 higher chance of being breastfeeding exclusively at the end of the third month and twice as high of still being breastfeeding at the end of the sixth month.CONCLUSION: Simple strategies to increase mother's knowledge regarding breastfeeding can have a positive impact on breastfeeding rates.

Supporting breastfeeding: a successful experience.

PIP: This paper relates the success of a study that helped enhance breast-feeding by means of a support group in Southern Brazil. The International Multicenter Growth Reference Study was designed to help WHO develop new growth charts to measure nutritional status of populations and to evaluate individual growth. Southern Brazil was one of the sites selected for the study, and an ongoing data collection for the longitudinal component of the study (based on children aged 0-24 months) began in July 1997. The new growth reference will be based on the growth of children with the following characteristics: gestational age at birth between 37 and 42 full weeks, single birth, lack of significant perinatal morbidity, absence of maternal smoking, no economic constraints on growth, and being breast-fed for at least 1 full year and given no other foods during the first 4-6 months. Since few mothers in Brazil follow this recommendation, a lactation support group was trained to help mothers breast-feed their babies. It was found that the breast-feeding support group really made a difference, at least with regard to the duration of breast-feeding. Mothers who had support breast-fed longer and waited longer to introduce other foods into their children's diet compared to those who had no support. The factors that contributed to increased breast-feeding duration are enumerated. In conclusion, supporting mothers in breast-feeding is beneficial to both mothers and children and can lead to a better quality of life.^ieng

[Identification of the groups most vulnerable to infant malnutrition through the measuring of poverty level]. / Identificação de grupos mais vulneráveis à desnutrição infantil pela medição do nível de pobreza.

OBJECTIVE: To test an instrument measuring the socioeconomic level, specially designed for low income urban populations, to be used in the identification of groups more vulnerable to infant malnutrition. POPULATION AND METHODS: This is a cross-sectional study, with a sample of 477 children aged 12 to 59 months old living in low income census sectors at "Vila Grande Cruzeiro", in Porto Alegre, RS. The children were submitted to anthropometric evaluation and their families were stratified according to socioeconomic level measured through an instrument developed in Chile for urban poor populations and adapted to local conditions. Children with weight/age, height/age and/or weight/height below - 2 standard deviation from the median of the reference population (NCHS) were considered malnourished. RESULTS: The children from families belonging to the lowest quartile in the socioeconomic classification had a 3.4 times higher chance of having low weight for age, a 2.7 times higher chance of being stunted and a 11.0 times higher chance of presenting low weight for height, controlling for potential confounders. CONCLUSION: The instrument measuring poverty level was useful to identify those children with higher risk for malnutrition.

Poverty levels and children's health status: study of risk factors in an urban population of low socioeconomic level.

To test the hypothesis that the low socioeconomic population living in shanty towns in Porto Alegre presents different levels of poverty which are reflected on its health status, a cross-sectional study was designed involving 477 families living in Vila Grande Cruzeiro, Porto Alegre, Brazil. The poverty level of the families was measured by using an instrument specifically designed for poor urban populations. Children from families living in extreme poverty (poorest quartile) were found to have higher infant mortality rate, lower birth weights, more hospitalizations, and higher malnutrition rates, in addition to belonging to more numerous families. Thus, the shanty town population of Porto Alegre is not homogeneous, and priority should be given to the more vulnerable subgroups.

[Maternal knowledge on breastfeeding and related factors]. / Conhecimentos maternos em amamentação e fatores associados.

The influence of maternal knowledge about breastfeeding on the initiation and duration of lactation has been described. The present study evaluated the maternal knowledge about breastfeeding and its relationship with prenatal and postnatal orientation and prevalence of breastfeeding at 3 months. A cross-sectional study was designed involving 100 mothers of first-born babies between 6 and 12 months old receiving medical care in the Hospital de Clínicas de Porto Alegre. The mothers answered a standardized questionnaire containing 14 questions to test knowledge on breastfeeding. The majority of mothers (62%) could not answer correctly half of the questions. Those more educated, who received prenatal orientation about breastfeeding and who had at least 5 prenatal visits had better knowledge. On the other hand, mothers who received postnatal orientation did not present a better knowledge. Prevalence of breastfeeding at 3 months was not related to maternal knowledge on the subject. The maternal knowledge about many aspects of breastfeeding was low. Postnatal orientation did not increase this knowledge. On the other hand, prenatal orientation had a positive impact on maternal knowledge about breastfeeding. Nonetheless this increase in knowledge was not sufficient to interfere with the prevalence of early interruption of breastfeeding.

Are fathers prepared to encourage their partners to breast feed? A study about fathers' knowledge of breast feeding.

In order to study fathers' knowledge of breast feeding and its relationship with paternal factors, fathers of 92 breast feeding and 89 non-breast feeding newborns were compared. Paternal factors included previous children and the way they were fed, participation in prenatal care, attendance at prenatal classes, breast feeding information provided by health professionals, use of reading materials and interest in learning more about the subject. The results indicated that fathers had poor knowledge about breast feeding, especially those whose children were being bottle fed. After adjustments for confounders, fathers who had previous breast-fed child(ren), had attended prenatal classes and who received information about breast feeding from medical personnel had a significantly higher chance of having a better knowledge of breast feeding. It seems that fathers need to be better prepared to assume their new role as breast feeding supporters. Prenatal care was shown to be a good opportunity to improve fathers' knowledge of breast feeding.

Effect of breastfeeding support from different sources on mothers' decisions to breastfeed.

A cross-sectional study compared 100 breastfeeding and 100 non-breastfeeding new mothers in order to investigate the relationship between mothers' choice of breastfeeding and support from health professionals and lay people, taking into account potentially confounding sociodemographic influences. The importance of the male partners' opinion about breastfeeding was also examined. A favorable attitude of partners towards breastfeeding was the most important factor associated with breastfeeding (odds ratio = 32.8). Prenatal class attendance and breastfeeding support from lay people increased the odds of breastfeeding 2.7 and 3.3 times, respectively. Breastfeeding orientation provided by doctors, nurses, and nutritionists was not associated with the maternal decision to breastfeed. The results point toward the need for reevaluation of prenatal care interventions, inclusion of fathers in breastfeeding educational programs, and emphasis on community-based programs.

[Breast-feeding: how and why to promote it]. / Amamentação: como e por que promover.

Breastfeeding promotion must be seen as a priority for the improvement of health and quality of life of children and their families. The strategies should vary according to the population, its culture, habits, beliefs, socio-economic level and other characteristics. Nevertheless, awareness of the importance of breastfeeding is crucial in any strategy. This review article aims to increase this awareness among health professionals. Epidemiologic evidences of the importance of breast feeding for the mother and child health are addressed. Emphasis is given to the impact of breastfeeding on infant mortality, morbidity and nutritional status, as well as on birth spacing. Further, this article discusses some breastfeeding promotion activities, specially educational programs for health professionals, pregnant women, parturients and general population. Changes in hospital routines, mass media,milk substitute marketing, protection of working mothers and community activities are also addressed.

[Follow-up of children with moderate or severe malnutrition in the peripheral population (Brazil)]. / Seguimento de crianças com desnutrição moderada ou grave em população periférica (Brasil).

What happens to children who develop moderate or severe malnutrition? What is done for them? Keeping in mind these questions, the present research was undertaken with the following objectives: to assess the nutritional status of children who develop moderate or severe malnutrition before the age of 5 years, after a period from 2 to 4 years after diagnosis; to assess the nutritional status of the under 5-year old siblings of these children; to study the influence of nutritional programs available in the community for the improvement of the nutritional status of the malnourished children; and to identify factors interfering with nutrition of these children during the study period. After a period of 2 to 4 years from the time of diagnosis of moderate or severe malnutrition the authors tried to locate the families of 61 malnourished children of Porto Alegre, RS (Brazil). The mothers their substitutes were interviewed and the children and siblings under 5 years of age were weighed and measured. Thirty-nine children were located. Of these, 4 (10%) died and 22 (56%) presented an increase of at least 10% in weight for age. Of the 35 children who survived, 29 (82%) still presented some degree of malnutrition (weight/age < or = 90% of the standard), 25 (71%) were stunted (height/age < or = 95%), and 5 (14%) were wasted (weight/height < or = 90%). The nutritional status of the 5-year old siblings was similar to that of the malnourished children.(ABSTRACT TRUNCATED AT 250 WORDS)

Risk factors for early termination of breast feeding in Brazil.

A prospective study was undertaken to identify possible factors related to the duration of breast feeding. Two hundred and thirty-eight mothers who had delivered normal single babies with birth weights greater than 2.5 kg and had initiated breast feeding were randomly selected at the maternity hospital, Hospital de Clinicas de Porto Alegre, Brazil, and followed by mail questionnaires until termination of breast feeding, or until the end of the first year. If no reply was received, telephone contact or home visits were made. The group of mothers who stopped breast feeding prior to the end of the third month was compared with those who extended breast feeding beyond three months with respect to socioeconomic, biological, environmental, medical and psychological factors. The variables with a significant coefficient of association with early termination of breast feeding were maternal education, past experience with breast feeding, help of a maid, help with housework provided by a relative, breast feeding orientation during prenatal care and encouragement from the husband. These factors act simultaneously, with interactions among them.