Factors Associated with the Duration of Breastfeeding: The Practices of Mexican Mothers in a Megacity and in the Agricultural Town.

BACKGROUND: Breast milk is irreplaceable for healthy development. In Mexico, by 2019, the prevalence of exclusive breastfeeding (EBF) was low and the use of breastmilk substitutes (BMSs) was high. OBJECTIVE: The aim of this work was to evaluate the maternal and child characteristics related to breastfeeding (BF) duration and to the introduction of BMSs for residents of Mexico City (CdMX) and an agricultural town in Morelos. METHODS: A cross-sectional study was conducted with 160 mother-child binomials (0-15 months of age) from the megacity CdMX and the agricultural town. OUTCOMES: EBF and total breastfeeding (TBF) duration, age of transition to BMSs, and the introduction of complementary feeding (CF) were assessed. Associations with maternal and infant factors were assessed using Cox models. RESULTS: The prevalence of EBF in the joint samples at 5.9 months was 32.6% and 5.8% at 6 months. EBF was favored under the following conditions: living in CdMX, receiving prenatal care, no newborn hospitalization, and breastmilk provided as first food at birth. TBF was prolonged under the following conditions: older mother, female children, rooming-in care during puerperium, receiving BF upon discharge after birth, cohabiting with extended family, and having no siblings. The introduction of BMSs predominated under the following conditions: living in an agricultural town, BMSs given after birth before discharge, younger mother, worker mother, and lack of prenatal care. The early introduction of CF (before the fourth month) was 2% for CdMX and 14% for the agricultural town. CONCLUSIONS: The agricultural population had a higher risk of the premature interruption of EBF/TBF and the early introduction of BMSs and CF. Protective factors were family-friendly environments and being born in a baby-friendly hospital.

[Gynecological care to children and adolescents. Twelve-year experience at National Pediatrics Institute, Mexico]. / Atenció ginecológica a niñas y adolescentes. Doce años de experiencia en el Instituto Nacional de Pediatría.

BACKGROUND: In major regions of the world, the importance of gynecological care to children and adolescents has been recognized. There are multiple publications, journals and associations dedicated to this purpose. In Mexico, it has not been the case. OBJECTIVE: The aim of this publication is to raise awareness to the medical community about the importance of sub specialized gynecological care to children and adolescents. MATERIAL AND METHODS: Retrospective study. The number of office evalu- ations issued by the Department of Gynecology of the National Institute of Pediatrics (INP) from January 1, 2002 to December 31, 2013 were counted. Results were grouped by age groups. Group 1: 1 year or less. Group 2: 2 to 9 years. Group 3: 10 to 18 years. The major causes of morbidity were analyzed by groups and in general. RESULTS: In the 12 year period reported, 21,190 girls granted gynecological consultation: 15.2% were first consultations (n = 3,221), 74.76% subsequent consultations (n = 15,842) and 10.04% evaluations and interconsultations (n = 2,127). The yearly average was 1,766 consultations. From 2002 to 2005, two certififyed obstetrician-gynecologists (OB-GYN) worked in the Departament, with the subsecuent increase in the number of attentions; 2005 was the year with the highest productivity (2,265). From 2006, only one OB-GYN continued laboring, and the number of visits decreased gradually. 2013 was the year with fewer productivity (1,351). The main causes of morbidity were: abnormal uterine bleeding (26.48%), inflammatory conditions of vagina and vulva (13.58%), dysmenorrhea (12.31%); which occupied 52.37% of the total (10,404 / 19,867). 81% of the patients corresponded to group 3 (17,079/21,190). To a younger patient, corresponded a smaller number of visits. CONCLUSION: It is required to institute the subspecialty of Child and Adolescent Gynecology in Mexico and to establish Services formed by subspecialists in this matter in the top pediatric hospitals of the country.

Enfermedad por reflujo gastroesofágico: signos poco usuales / Disease for gastroesophageal reflux: unusual signs

Se evaluó la frecuencia de presentación de los signos poco usuales del reflujo gastroesofágico en 82 niños, con una edad de 1 mes a 12 años, con mediana de 5 meses. Los signos poco usuales fueron irritabilidad (manifestada por alteraciones en el sueño y llanto frecuente) en el 50%; posición de Sandifer en el 8.5%; sangre oculta en heces en el 29.2% y anorexia en el 4.8%. La irritabilidad se encontró como único síntoma en el 7.3% de todos los niños. Los signos habituales fueron vómitos en el 80%, regurgitaciones en el 26.8%, tos en el 19% y palidez en el 13.4%. Las complicaciones por reflujo gastroesofágico fueron esofagitis en 11 niños y estenosis esofágica en 2. Se concluye que la irritabilidad no es tan infrecuente como se ha escrito en la literatura. Debe considerarse el diagnóstico en un lactante que muestre llanto frecuente y alteraciones en el sueño.