Effects of non-nutritive sucking habits on malocclusions: a systematic review.

The development of the craniomandibular system is guided by genetic interactions and environmental factors, including specific habits such as breastfeeding, bottle feeding, thumb sucking and the use of pacifiers. These habits can have a considerable impact on the growth of the developing jaws and can lead to malocclusion in children. This review aims to investigate potential associations between non-nutritive sucking habits (NNSHs) and malocclusions compared to the presence of nutritive sucking habits (NSHs). To carry out this systematic review, we followed the PRISMA protocol and performed a bibliographic search of the existing literature until April 2023 in the following electronic databases: Medline, PubMed, The Cochrane Library and Embase. Out of a total of 153 records, we included 21 studies. We found that the chances of diagnosing a malocclusion were higher for children with bottle nutrition when compared to breast-fed children. Breastfeeding provides protection against malocclusions. In the same manner, persistent NNSH habits appeared to be associated with increased chances of having malocclusions. The longer the child was breastfed, the shorter the duration of the pacifier habit and the lower the risk of developing moderate/severe malocclusions. The duration of the habits has a positive influence on the appearance of occlusion defects.

Advancing the assessment of pacifier effects with a novel computational method.

BACKGROUND: Numerous studies have demonstrated a high likelihood of malocclusions resulting from non-nutritive sucking. Consequently, quantifying the impact of pacifiers can potentially aid in preventing the development or exacerbation of malocclusions and guide the design of improved performance pacifiers. METHODS: This work proposes and assesses a computational methodology that can effectively gather crucial information and provide more precise data regarding the consequences of non-nutritive pacifier sucking. The computational framework utilized is based on solids4Foam [1, 2], a collection of numerical solvers developed within the OpenFOAM® computational library [3]. The computational model focuses on the palate of a six-month-old baby and incorporates various components such as palate tissues, pacifier and tongue, and considers the negative intraoral pressure generated and the tongue displacement. Different models were tested, each offering varying levels of detail in representing the palate structure. These models range from a simplified approach, with one tissue, to a more intricate representation, involving up to five different tissues, offering a more comprehensive palate model compared to existing literature. RESULTS: The analysis of results involved examining the distribution of stress on the palate surface, as well as the displacement and forces exerted on the dental crowns. By comparing the obtained results, it was possible to evaluate the precision of the approaches previously described in the literature. The findings revealed that the predictions were less accurate when using the simplified model with a single tissue for the palate, which is the most common approach proposed in the literature. In contrast, the results demonstrated that the palate model with the most intricate structure, incorporating five different tissues, yielded distinct outcomes compared to all other combinations. CONCLUSIONS: The computational methodology proposed, employing the most detailed palate model, has demonstrated its effectiveness and necessity in obtaining accurate data on the impact of non-nutritive sucking habits, which are recognized as a primary contributor to the development of dental malocclusions. In the future, this approach could be extended to conduct similar studies encompassing diverse pacifier designs, sizes, and age groups. This would foster the design of innovative pacifiers that mitigate the adverse effects of non-nutritive sucking on orofacial structures.

Influence of bad oral habits upon the development of posterior crossbite in a preschool population.

BACKGROUND: A study is made of posterior crossbite in deciduous dentition and its possible association to extrinsic factors (bad oral habits). METHODS: A total of 1168 Spanish children between 3 and 6 years of age were included in the study. Exploration of the oral cavity was performed to assess the presence of crossbite (uni- or bilateral and/or functional), and a questionnaire was administered to the parents or caregivers to determine the presence of bad oral habits and their duration. RESULTS: In occlusion, 19.7% of the cases (n = 230) presented uni- or bilateral posterior crossbite. On adopting centric relation confronting the midlines, crossbite persisted in 165 children, indicating that 65 cases were due to premature contacts (functional crossbite). The identified favoring factors were pacifier use, thumb sucking, oral breathing and tongue thrusting or immature swallowing. DISCUSSION: Most studies in the literature report a relationship between posterior crossbite and bad oral habits. The proportion of posterior crossbites identified in our study (16.6%) is consistent with the data published by authors such as Kobayashi, Limeira or Paolantonio, among others, but differs from the results of Zhifei Zhou, Peres or Germa. In coincidence with most studies, we recorded a statistically significant association between posterior crossbite and bad oral habits. CONCLUSIONS: Bad oral habits favor the appearance of posterior crossbite, and the duration of the habit, its intensity (in the case of thumb sucking) and type (in the case of pacifier use) act as influencing factors. Functional study characterized the types of posterior crossbites and identified those attributable to premature contacts. This aspect has not been addressed by previous studies, and we consider the findings to be very interesting for analyzing and identifying the features of true crossbites.

Breastfeeding Protects from Overjet in Adolescence by Reducing Pacifier Use: A Birth Cohort Study.

Increased dental overjet in adolescence is a clinically relevant outcome associated with the complexity and high cost of treatment, indicating the need for prevention strategies. We investigated the long-term impact of breastfeeding and pacifier use on increased overjet (IOVJ) in permanent dentition. A prospective cohort nested in a randomized controlled trial was conducted from birth to 12 years of age (n = 214). Breastfeeding and pacifier use were recorded monthly until 12 months. Overjet was assessed at age 12 years. We employed a causal mediation analysis using parametric regression models assuming no interaction between breastfeeding and pacifier usage. We found a total protective effect of breastfeeding on IOVJ (OR 0.49; 95% CI 0.28-0.96), where 63.1% were mediated by pacifier use (OR 0.61; 95% CI 0.44-0.87). Breastfeeding directly decreased the odds of IOVJ by 20%; however, the confidence interval included the null estimate (OR 0.81; 95% CI 0.41-1.60). In conclusion, breastfeeding protects by half of the IOVJ in adolescence through reducing pacifier use. Oral and general health professionals should collaborate to support WHO breastfeeding guidelines during individual patient counseling. Guidelines for practice, policy or public information require messages that include a common risk approach to oral and general health.

Perception of pacifier use among caregivers of infants 0-1 years of age.

American Academy of Pediatrics approves pacifier use for soothing and calming; it recommends delaying its use until breastfeeding is well established. Though pacifiers have protective effects against sudden infant death syndrome, prolonged use of a pacifier can lead to complications. American Academy of Family Physicians discourages the use by 6 months to 1 year of age. Pacifier use guidelines are not established primarily due to a paucity of information regarding initiation, termination, benefits, and harmful effects of pacifiers by parents. We aim to investigate pacifier use among caregivers of 0-1-year-old infants. It was a descriptive study of parents or caregivers of children 0-1 year of age who completed a questionnaire focused on pacifier use. Statistical analysis was calculated using SPSS version 23. One hundred thirty-three caregivers were interviewed. One hundred eighteen (88.7%) caregivers were mothers. Ninety-one (68.4%) of caregivers identified as Hispanic and 42 (30.1%) as African American. Caregivers reported that mean pacifier use was 16 months and 3.4 h/day. One hundred six (80%) reported the most common use of the pacifier alone was to calm the baby. For the weaning method, 37 (27.8%) stated that gradual decrease of pacifiers was useful whereas 33 (24.8%) stated that abrupt removal of pacifiers was effective. Seventy-two (54.1%) reported that their family and friends recommended pacifiers. Eleven (8.3%) caregivers reported that information about pacifiers was provided by medical and day-care providers. Pacifier use was not significantly related to the feeding method during the first 2 months of life. This study identifies impressions and common misconceptions of pacifier use which may assist in the development of comprehensive guidelines.

Avaliação da eficácia do acessório mamilo na remoção dos hábitos deletérios / Evaluation of the effectiveness of the nipple accessory in the removal of the deletery habits

Objetivo: avaliar a eficácia do acessório mamilo aplicado a aparelhos ortopédicos/ ortodônticos no tratamento de hábitos deletérios de sucção de chupeta, língua, lábio e dedo, e onicofagia em pacientes tratados nos últimos 20 anos com o aparelho. Métodos: Trata-se de um estudo clínico observacional, retrospectivo, no qual a amostra foi composta de prontuários de pacientes de ambos os gêneros, atendidos por profissionais habilitados pelo aparelho mamilo, que os utilizaram em crianças de 03 a 16 anos portadoras de hábitos deletérios. Os prontuários utilizados, correspondem a pacientes tratados entre os anos 2000 a 2020. Todas as análises foram realizadas no programa R, com nível de significância de 5%. Resultados: Foram analisados 142 prontuários, nos quais 122 foram incluídos, por estarem dentro dos critérios de inclusão propostos no estudo e 20 foram excluídos da pesquisa por apresentarem informações incompletas e/ou não preenchidas corretamente. O hábito com maior incidência foi o de sucção digital, em 71,3% dos pacientes, 91,8% dos pacientes deixaram o hábito, destacando que nos casos de sucção de chupeta e onicofagia, o sucesso na remoção do hábito foi de 100%, em ambos os casos. O tempo médio de uso do aparelho foi de 4,8 meses, variando de 0,6 a 14 meses. O tempo médio para a remoção do hábito após a instalação do aparelho foi de 1,6 meses, variando de 0 a 12 meses. Conclusão: O aparelho mamilo, mostra-se como uma alternativa de alta eficácia na remoção de hábitos deletérios de sução de chupeta, dedo, língua e onicofagia.(AU)

Objective: Evaluate the effectiveness of the nipple accessory applied to orthopedic/orthodontic appliances in the treatment of harmful pacifier, tongue, lip and finger sucking habits, and onychophagia in patients treated in the last 20 years with the device. Methods: This is an observational, retrospective clinical study, in which the sample consisted of medical records of patients of both genders, assisted by professionals qualified by the nipple device, who used them in children aged 03 to 16 years with deleterious habits. The medical records used correspond to patients treated between the years 2000 and 2020. All analyzes were performed in the R program, with a significance level of 5%. Results: 142 medical records were analyzed, in which 122 were included, as they were within the inclusion criteria proposed in the study and 20 were excluded from the research because they presented incomplete information and/or not filled in correctly. The habit with the highest incidence was digital sucking, in 71.3% of patients, 91.8% of patients quit the habit, noting that in cases of pacifier sucking and onychophagia, success in removing the habit was 100%, in both cases. The average time of use of the device was 4.8 months, ranging from 0.6 to 14 months. The mean time to remove the habit after installing the device was 1.6 months, ranging from 0 to 12 months. Conclusion: The nipple device is a highly efficient alternative for removing harmful habits of pacifier, finger, tongue and onychophagy sucking.(AU)

Os malefícios da "Luva Chupeta" de látex na Unidade Neonatal / The harmful effects of the latex "Glove Pacifier" in the Neonatal Unit / Los efectos nocivos del "Guante Chupete" de látex em La Unidad Neonatal

Na Iniciativa Hospital Amigo da Criança-Neofoi proposto o uso da chupeta na Unidade Neonatal (UN) de modo terapêutico, e sempre com supervisão de um profissional de saúde. Mas observa-se que o aparato conhecido como "Luva Chupeta" fabricado com o uso de uma luva de látex está sendo utilizado como alternativa para acalentar o recém-nascido (RN). Apesar de poucos estudos, é evidente que esse dispositivo deve ser contraindicado na UN, uma vez que pode provocar alergia ao látex, transmitir infecções, provocar acidentes graves como aspiração laringotraqueal do algodão devido ao rompimento da luva de látex, e dependendo do tamanho do material, obstruir as vias aéreas, e levar a óbito. Além do mais, o dispositivo pode interferir negativamente no crescimento e no desenvolvimento craniofacial e causar prejuízos associados à amamentação e na saúde materno infantil. A substituição da "Luva Chupeta" por outras estratégias, até mesmo pela chupeta convencional ou ortodôntica, para lidar com a dor e situações de estresse do RN deve ser decisiva para evitar os riscos de acidentes graves. O Protocolo de uso de bicos, Protocolo de manejo da dor do RN, adoção do Método Canguru na UN para promoção do desenvolvimento e comportamento do RN, e a capacitação/monitoramento das práticas adotas pela Equipe Materno Infantil, quanto ao cuidado ofertado são alternativas mais complexas, mas que devem ser analisadas por aqueles que desejam oferecer confiabilidade aos seus processos institucionais. (AU)

In the Baby-Friendly Hospital-Neo Initiative, the use of pacifiers in the Neonatal Unit (UN) was proposed in a therapeutic way, and always under the supervision of a health professional. However, it should be noted that the device known as "Pacifier Glove" manufactured using a latex glove is being used as an alternative to cherish the newborn. Despite few studies, it is clear that this device should be contraindicated in the UN, since it can cause allergy to latex, transmit infections, cause serious accidents such as laryngotracheal aspiration of cotton due to the rupture of the latex glove, and depending on the size of the material, obstruct the airways, and lead to death. Furthermore, the device may interfere with craniofacial growth and development and cause harm associated with breastfeeding and maternal and child health. The substitution of the "Pacifier Glove" for other strategies, even for the conventional or orthodontic pacifier, to deal with the pain and stress situations of the baby should be avoided to avoid the risk of serious accidents.The teat use protocol, the baby's pain management protocol, the adoption of the Kangaroo Method in the neonatal unit to promote the baby's development and behavior, and the training/monitoring of the practices adopted by the Maternal and Child Team, regarding the care offered, are alternatives more complex, but which must be analyzed by those who wish to offer reliability to their institutional processes. (AU)

En la Iniciativa Hospital Amigo del Niño-Neo, se propuso terapéuticamente el uso del chupete en la Unidad Neonatal (UN), y siempre bajo la supervisión de un profesional de la salud. Pero se observa que el dispositivo conocido como "chupete Gluva", fabricado con el uso de un guante de látex, está siendo utilizado como una alternativa para cuidar al recién nacido (NB). A pesar de los pocos estudios, es evidente que este dispositivo debe estar contraindicado en la NU, ya que puede causar alergia al látex, transmitir infecciones, ocasionar accidentes graves como aspiración laringotraqueal de algodón por rotura del guante de látex, y dependiendo de la El tamaño del material obstruye las vías respiratorias y provoca la muerte. Además, el dispositivo puede interferir negativamente con el crecimiento y desarrollo craneofacial y causar daños asociados con la lactancia materna y la salud maternoinfantil. La sustitución del "Dummy Glove" por otras estrategias, incluso el chupete convencional u ortodóncico, para hacer frente a las situaciones de dolor y estrés del RN debe ser determinante para evitar el riesgo de accidentes graves. El Protocolo de Uso del Pezón, el Protocolo de Manejo del Dolor del RN, la adopción del Método Canguro en la NU para promover el desarrollo y comportamiento del RN, y la capacitación/seguimiento de las prácticas adoptadas por el Equipo Materno Infantil, en cuanto a los cuidados ofrecidos, son más alternativas eficientes, complejas, pero que deben ser analizadas por quienes deseen brindar confiabilidad a sus procesos institucionales. (AU)

Forces Generated During Plush Animal Pacifier Use: A Pilot Study.

PURPOSE: Plush animal pacifiers (detachable weighted stuffed animals) have gained popularity. Although pacifiers have well-known benefits, they can also affect the development of the cranio-facial-respiratory complex. The purpose of this study was to study the forces gener- ated on the maxillary arch region during the use of plush animal pacifiers. METHODS: Products were tested using an Instron model 1011 machine. A fixture was developed to standardize the testing of the various brands. Each item tested was suspended on a pin eight mm from the pacifier shield, and the position of the Instron pushing apparatus was standardized throughout the testing. RESULTS: Generated forces from all Plush animal pacifiers tested fell in the range of 0.47 N to 0.7 N (47.9 g to 71.4 g). The force of the pacifier alone fell in the range of 0.05 N to 0.2 N (5.1 g to 20.4 g). CONCLUSIONS: When toy plush animals are attached to a pacifier, the forces transmitted to the nipple of the pacifier can exceed the 0.4 N minimum force (100 g equals 0.98 N) required to cause orthodontic tooth movement.

Socio-demographic, maternal, and infant characteristics associated with pacifier use among six-months old infants in Clark County, Nevada.

BACKGROUND: Pacifier use can interfere with nurturing care practices such as breastfeeding, soothing, and sleeping. Due to contradicting beliefs, recommendations, and the high frequency of pacifier use, understanding its associations may support shaping equitable public health recommendations. This study explored the socio-demographic, maternal, and infant characteristics associated with pacifier use among six-months old infants in Clark County, Nevada. METHOD: Cross-sectional survey was conducted in 2021 with a sample of mothers (n = 276) of infants under six months old in Clark County, Nevada. Participants were recruited through advertisements in birth, lactation, pediatric care centers, and social media. We used binomial and multinomial logistic models to assess the association between pacifier use and the age of pacifier introduction, respectively, with household, maternal, infant, healthcare characteristics, and feeding and sleeping practices. RESULTS: More than half of the participants offered pacifiers (60.5%). Pacifier use was higher among low-income households (OR (95% CI) 2.06 (0.99-4.27)), mothers who identified as non-Hispanic (OR (95% CI) 2.09 (1.22-3.59)), non-first-time mothers (OR (95% CI) 2.09 (1.11-3.05)), and bottle-feeding infants (OR (95% CI) 2.76 (1.35-5.65)). Compared to those who did not introduce a pacifier, non-Hispanic mothers (RRR (95% CI) 2.34 (1.30-4.21)) and bottle-fed infants (RRR (95% CI) 2.71 (1.29-5.69)) had a higher risk of introducing pacifier within two weeks. Likewise, infants living in food insecure households (RRR (95% CI) 2.53 (0.97-6.58)) and mothers who have more than one child (RRR (95% CI) 2.44 (1.11-5.34)) had a higher risk of introducing a pacifier after two weeks. CONCLUSION: Pacifier use is independently associated with maternal income, ethnicity, parity, and bottle feeding among six-month-old infants living in Clark County, Nevada. Household food insecurity increased the relative risk of introducing a pacifier after two weeks. Qualitative research on pacifier use among families with diverse ethnic/racial backgrounds is needed to improve equitable interventions.

Análise comparativa entre a influência da amamentação e hábitos bucais deletérios no crescimento craniofacial / Comparative analysis between the influence of breastfeeding and deleterial oral habits on craniofacial growth

A adoção da chupeta e mamadeira pelos pais podem trazer problemas no desenvolvimento craniofacial da criança. A sucção digital é outro fator influenciador da má formação da face, este pode ser antecedido pela mamadeira e chupeta. O conhecimento sobre o desenvolvimento facial correto ajuda no reconhecimento de desvios da normalidade. Foi realizada uma revisão da literatura a fim de analisar e comparar os efeitos no crescimento facial entre os hábitos deletérios e a amamentação fisiológica. Muitos registros de malformações causadas por hábitos deletérios foram encontrados. Conclui-se que a amamentação natural ainda é a melhor forma de alimentação para crianças, e nenhuma outra opção será melhor que a fisiológica, sendo aconselhável evitar o uso dos demais(AU)

The adoption of pacifiers and bottles by parents can bring problems in the child's craniofacial development. Finger sucking is another factor influencing the malformation of the face, which can be preceded by the bottle and pacifier. Knowledge about correct facial development helps in recognizing deviations from normality. A literature review was carried out in order to analyze and compare the effects on facial growth between harmful habits and physiological breastfeeding. Many records of malformations caused by deleterious habits were found. It is concluded that natural breastfeeding is still the best form of feeding for children, and no other option will be better than the physiological one, being advisable to avoid the use of the others(AU)

Tratamento de mordida aberta causada por excessivo hábito de sucção de chupeta por meio de uma abordagem psico-pedagógica. acompanhamento por 11 anos: relato de caso / Treatment of open bite caused by excessive pacifier sucking through a psycho-pedagogical approach. follow-up for 11 years: case report

Objetivo: reportar o sucesso da utilização de uma abordagem psico-pedagógica precoce para resolução de uma mordida mordida aberta lateral causada por sucção de chupeta. Relato do caso: paciente com 3 anos de idade em dentadura decídua, sexo feminino, apresentando mordida aberta unilateral. Foi empregada uma técnica psico-pedagógica, utilizando terapia cognitivo-comportamental para ajudar a criança a lidar com questões, como estresse e ansiedade, por meio da contação de histórias por meio de livros infantis especializados. Resultado: após 2 anos de acompanhamento a mordida aberta foi completamente corrigida e não houve recorrência do hábito. Após 11 anos de acompanhamento, observou- se estabilidade da auto-correção, sem recorrência da mordida aberta lateral. Conclusão: uma vez que crianças em idade pré-escolar podem não apresentar maturidade suficiente para uso de aparelhos interceptativos, uma abordagem psico-pedagógica pode ser uma opção de tratamento viável.

Objective: the purpose of this article is to report a successful approach in an early psycho-pedagogical approach in a case of lateral open bite. Case report: a 3-year-old female patient in deciduous dentition presenting an unilateral open bite. A psycho-pedagogical technique was employed, using cognitive behavioral therapy to help the children to deal with issues, as stress and anxiety through the storytelling by means of specialized children´s books. No interceptive conduct was used. Results: after 2 years of follow-up, the open bite was completely corrected and there was no recurrence of the habit. After 11 years of follow-up, stability of self-correction was observed, with no recurrence of lateral open bite. Conclusion: since preschool-aged children may not be mature enough to use orthodontic interceptive devices, a psycho-pedagogical approach may be a viable treatment option.

Non-Nutritive Suckling System for Real-Time Characterization of Intraoral Vacuum Profile in Full Term Neonates.

Infant breastfeeding diagnostics remain subjective due to the absence of instrumentation to objectively measure and understand infant oral motor skills and suckling characteristics. Qualitative diagnostic exams, such as the digital suck assessment which relies upon a clinician's gloved finger inserted into the infant's mouth, produce a diversity of diagnoses and intervention pathways due to their subjective nature. In this paper, we report on the design of a non-nutritive suckling (NNS) system which quantifies and analyzes quantitative intraoral vacuum and sucking patterns of full-term neonates in real time. In our study, we evaluate thirty neonate suckling profiles to demonstrate the technical and clinical feasibility of the system. We successfully extract the mean suck vacuum, maximum suck vacuum, frequency, burst duration, number of sucks per burst, number of sucks per minute, and number of bursts per minute. In addition, we highlight the discovery of three intraoral vacuum profile shapes that are found to be correlated to different levels of suckling characteristics. These results establish a framework for future studies to evaluate oromotor dysfunction that affect the appearance of these signals based on established normal profiles. Ultimately, with the ability to easily and quickly capture intraoral vacuum data, clinicians can more accurately perform suckling assessments to provide timely intervention and assist mothers and infants towards successful breastfeeding outcomes.

Examining the association between prenatal maternal stress and infant non-nutritive suck.

BACKGROUND: This study examined the relationship between prenatal maternal stress (PREMS) and non-nutritive suck (NNS) and tested its robustness across 2 demographically diverse populations. METHODS: The study involved 2 prospective birth cohorts participating in the national Environmental influences on Child Health Outcomes (ECHO) Program: Illinois Kids Development Study (IKIDS) and ECHO Puerto Rico (ECHO-PROTECT). PREMS was measured during late pregnancy via the 10-item Perceived Stress Scale (PSS-10). NNS was sampled from 1- to 8-week-olds using a custom pacifier for ~5 min. RESULTS: Overall, 237 mother-infant dyads completed this study. Despite several significant differences, including race/ethnicity, income, education, and PREMS levels, significant PREMS-NNS associations were found in the 2 cohorts. In adjusted linear regression models, higher PREMS, measured through PSS-10 total scores, related to fewer but longer NNS bursts per minute. CONCLUSIONS: A significant association was observed between PREMS and NNS across two diverse cohorts. This finding is important as it may enable the earlier detection of exposure-related deficits and, as a result, earlier intervention, which potentially can optimize outcomes. More research is needed to understand how NNS affects children's neurofunction and development. IMPACT: In this double-cohort study, we found that higher maternal perceived stress assessed in late pregnancy was significantly associated with fewer but longer sucking bursts in 1- to 8-week-old infants. This is the first study investigating the association between prenatal maternal stress (PREMS) and infant non-nutritive suck (NNS), an early indicator of central nervous system integrity. Non-nutritive suck is a potential marker of increased prenatal stress in diverse populations. Non-nutritive suck can potentially serve as an early indicator of exposure-related neuropsychological deficits allowing for earlier interventions and thus better prognoses.

Association between Pacifier Use, Bottle-Feeding, and Pre-Postnatal Variables: A Cohort Study

ABSTRACT Objective: To determine the prevalence and analyze the variables associated with the use of pacifiers and/or bottles by infants up to 6 months of age. Material and Methods: Data on sociodemographic characteristics, intention to offer pacifier and bottle-feeding, pregnancy and breastfeeding (BF) variables were collected at baseline by interviews and a self-administered questionnaire among pregnant women in the 3rd trimester. After delivery, mother-baby binomials were followed by phone calls at the 1st, 3rd, and 6th months of the baby's life (n=467) to gather information on the type of delivery, baby's gender, BF in the first hour of the newborn's life, baby's weight, mother's return to work, and oral habits. Association analyses were performed using logistic regression models with a 5% significance level with the pacifier/bottle-feeding use as the outcome. Results: Most mothers (52.5%) reported their babies used bottle-feeding, 48.2% used pacifiers and 33.4% used both of them throughout the 6 months. Intention to offer pacifier and bottle-feeding was reported by 45.0% and 54.8% of the mothers at the 3rd trimester of the pregnancy, respectively. Not living in one's own residence (OR=1.53; 95%CI: 1.05-2.24) and having the prenatal intention of offering a pacifier (OR=2.50; 95%CI: 1.63-3.83) to the baby were significantly associated with pacifier use. Variables significantly associated with bottle-feeding were mother's return to work (OR=2.48; 95%CI: 1.54-3.97), baby's lower birth weight (OR=1.58; IC95%: 1.07-2.33), and prenatal intention to offer bottle-feeding (OR=2.51; 95%CI 1.56-4.04). Conclusion: About half of the babies used pacifiers or were bottle-fed, which were associated with the mother's prenatal intention to offer them to their babies and socioeconomic factors.

Evaluation of the effect of nutritive versus non-nutritive pacifiers as adjuncts to local anaesthesia in male neonatal circumcision using the plastibell technique - A prospective randomised controlled study.

Background: Male circumcision is the most common surgical procedure worldwide and is often carried out for religious, cultural, medical and public health reasons. It is commonly performed during the neonatal period. Many studies have now shown that pain is a common intra- and post-operative complication. To ensure proper analgesia during the procedure, many surgeons opt for the use of pacifiers as an adjunct to anaesthesia during neonatal circumcision. The aim of this study is to compare nutritive pacifiers (NPs) versus non-NPs (NNPs) as adjuncts to local anaesthesia in male neonatal circumcision using the Plastibell technique. Methods: A prospective randomised controlled study was carried out between October 2019 and March 2020. A total of 100 neonates were circumcised using the Plastibell technique and randomised into NP (Group A, n = 33), NNP (Group B, n = 33) and controls (Group C, n = 34), respectively. The differences in pain scores using the Neonatal Infant Pain Scale, total crying time and heart rate during circumcision were recorded and assessed. Results: The age of participants ranged from 5 to 28 days and the weight ranged from 2.5 to 5.0 kg. The overall mean age, birth weight and current weight of the participants were 15.5 ± 6.1 days, 3.4 ± 0.4 kg and 3.5 ± 0.6 kg, respectively. The control group had the highest average pain score of 5.5 (4.5-5.8) compared to the intervention groups with median pain score (NP: 3.3 [1.3-4.3] and (NNP: 4.3 [3.1-5.1], respectively). NPs had significantly lower pain scores (P = 0.023) and reduced total crying time (P = 0.019) at all stages of the circumcision compared to those given NNPs and controls. Conclusion: This study showed that NPs were superior to NNPs in providing additional pain control during male neonatal circumcision.

Evidence Base for 2022 Updated Recommendations for a Safe Infant Sleeping Environment to Reduce the Risk of Sleep-Related Infant Deaths.

Every year in the United States, approximately 3500 infants die of sleep-related infant deaths, including sudden infant death syndrome (SIDS) (International Statistical Classification of Diseases and Related Health Problems 10th Revision [ICD-10] R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75). After a substantial decline in sleep-related deaths in the 1990s, the overall death rate attributable to sleep-related infant deaths have remained stagnant since 2000, and disparities persist. The triple risk model proposes that SIDS occurs when an infant with intrinsic vulnerability (often manifested by impaired arousal, cardiorespiratory, and/or autonomic responses) undergoes an exogenous trigger event (eg, exposure to an unsafe sleeping environment) during a critical developmental period. The American Academy of Pediatrics recommends a safe sleep environment to reduce the risk of all sleep-related deaths. This includes supine positioning; use of a firm, noninclined sleep surface; room sharing without bed sharing; and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include human milk feeding; avoidance of exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs; routine immunization; and use of a pacifier. New recommendations are presented regarding noninclined sleep surfaces, short-term emergency sleep locations, use of cardboard boxes as a sleep location, bed sharing, substance use, home cardiorespiratory monitors, and tummy time. In addition, additional information to assist parents, physicians, and nonphysician clinicians in assessing the risk of specific bed-sharing situations is included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, which is included in this issue.