Mechanical stress distribution over the palate by different pacifiers assessed by finite element analysis and clinical data.

The mechanical behavior of each type of pacifier on rigid structures and their various impacts on orofacial growth have yet to be discovered. The study aimed to evaluate the stress distribution over a child's palate by three types of pacifiers using finite element analysis and clinical and laboratory data. Modulus of elasticity was obtained from 30 specimens comprising 10 of each conventional (A), orthodontic (B), and breast-shaped (C) pacifiers. Tongue strength was assessed in eight 3-year-old children (kPa). A hemi-maxilla model was obtained from 2- to 3-year-old skull tomography, and the images of pacifiers A, B, and C were captured using 3D scanning. The Hypermesh® program generated a mesh of 6-node tetrahedral elements for applying forces in the X, Y, and Z directions to enable a nonlinear analysis. Pacifier B exhibited the highest values for distributed stress on the palate, followed by pacifier A. Pacifier B stimulated the maxilla forward and sideways. In contrast, pacifier A promoted a forward and upward load, favoring a more atresic palate. Pacifiers A and B tended to rotate in the sagittal plane, generating tensions in the anterior incisors and favoring the open bite. Pacifier C exhibited lateral expansion by stress induction over the mid-palatal suture with less influence on incisor inclination. Pacifiers showed different detrimental stress distributions on the palate. This information can be helpful for improving recommendations given to parents.

Comparison of the effect of two methods of sucking on pacifier and mother's finger on oral feeding behavior in preterm infants: a randomized clinical trial.

BACKGROUND: Oral feeding problems will cause long-term hospitalization of the infant and increase the cost of hospitalization. This study aimed to compare the effect of two methods of sucking on pacifier and mother's finger on oral feeding behavior in preterm infants. METHODS: This single-blind randomized controlled clinical trial was performed in the neonatal intensive care unit of Babol Rouhani Hospital, Iran. 150 preterm infants with the gestational age of 31 to 33 weeks were selected and were divided into three groups of 50 samples using randomized block method, including non-nutritive sucking on mother's finger (A), pacifier (B) and control (C). Infants in groups A and B were stimulated with mother's finger or pacifier three times a day for five minutes before gavage, for ten days exactly. For data collection, demographic characteristics questionnaire and preterm infant breastfeeding behavior scale were used. RESULTS: The mean score of breastfeeding behavior in preterm infants in the three groups of A,B,C was 12.34 ± 3.37, 11.00 ± 3.55, 10.40 ± 4.29 respectively, which had a significant difference between the three groups (p = 0.03). The mean rooting score between three groups of A, B, and C was 1.76 ± 0.47, 1.64 ± 0.48, and 1.40 ± 0.90 (p < 0.001) respectively. Also, the mean sucking score in groups of A, B and C was 2.52 ± 0.76, 2.28 ± 0.64 and 2.02 ± 0.74 respectively, which had a significant difference (p = 0.003), but other scales had no significant difference between the three groups (P > 0.05). The mean time to achieve independent oral feeding between the three groups of A, B, C was 22.12 ± 8.15, 22.54 ± 7.54 and 25.86 ± 7.93 days respectively (p = 0.03), and duration of hospitalization was 25.98 ± 6.78, 27.28 ± 6.20, and 29.36 ± 5.97 days (p = 0.02), which had a significant difference. But there was no significant difference between the two groups of A and B in terms of rooting, sucking, the total score of breastfeeding behavior and time of achieving independent oral feeding (P > 0.05). CONCLUSION: Considering the positive effect of these two methods, especially non-nutritive sucking on mother's finger, on increasing oral feeding behaviors, it is recommended to implement these low-cost methods for preterm infants admitted to neonatal intensive care unit. TRIAL REGISTRATION: Trial Registration: IRCT, IRCT20191116045460N1 . Registered 11 January 2020- prospective registered.

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.

Evaluation of Effect of Orthodontic Pacifiers in Prevention of Sudden Infant Death Syndrome: A Finite Element Method and Questionnaire Based Study.

INTRODUCTION: Considering the morbidity associated with Sudden Infant Death Syndrome (SIDS) and limitations of absence of such syndrome in animals, a retrospective survey based human study and prospective Finite Element Method (FEM) study was planned to evaluate the effect of orthodontic pacifier in prevention of SIDS. STUDY DESIGN: Two groups, Group I (case) consisting of 48 people, who had lost their infant due to SIDS in past, and Group II (control) consisting of 200 participants with infant in the family, were established. The study was conducted in two parts. An online questionnaire-based survey consisting of 20 multiple choice questions was conducted to establish the correlation of pacifiers in families affected with SIDS. Thereafter, FEM evaluation was carried out in two age groups (up to six months, and between seven to 12 months) with two different pacifiers i.e. conventional and orthodontic, and one human nipples. RESULTS: 12 participants from case group and 170 in control group gave history of using pacifier for their infants between 2 to 6 months. The frequency and duration of use of pacifiers in case group generally increased while infant cried as high as 66 percent in frequency and 75 percent in duration in comparison to 90 percent in control group. FEM analysis showed significant stresses incurred with conventional pacifiers in relation to oral cavity and tongue. Orthodontic pacifiers exhibited human nipple like effect with more pronounced effects on posterior oral cavity and lesser strain on soft and hard tissues. CONCLUSION: Promising results obtained with survey and positive correlation of FEM data with orthodontic pacifiers indicates the superiority and advantages of orthodontic pacifiers in prevention of SIDS.

Use of Artificial Nipples Among Brazilian Infants and Associated Factors.

Transversal study conducted in a Human Milk Bank to evaluate the factors associated with the use of artificial nipples (pacifier and/or nursing bottle) among Brazilian infants. Analyses were performed using the χ2 test and logistic regression analysis. A total of 6017 nursing mothers were evaluated and the use of artificial nipples was reported by 31.3%. The chance of using artificial nipples was higher among infants whose mothers attended antenatal care in private hospitals [odds ratio (OR): 1.61, 95% confidence interval (CI) 1.21-2.14], born in maternities without the Baby-Friendly Hospital Initiative (BFHI) (OR: 18.38, 95% CI 13.50-25.04) and those with adequate birth weight (OR: 2.83, 95% CI 1.99-4.03). A lower chance of using artificial nipples was observed among infants whose mothers had previous breastfeeding experience (OR: 0.76, 95% CI 0.61-0.95), received guidance on breastfeeding during antenatal care (OR: 0.80, 95% CI 0.65-0.98), practiced exclusive breastfeeding (OR: 0.36, 95% CI 0.28-0.45), breastfeeding on demand (OR: 0.66, 95% CI 0.52-0.85) and residents of inland cities/towns (OR: 0.38, 95% CI 0.20-0.72). The findings highlight the importance of breastfeeding guidance during antenatal care and the role of BFHI in clarifying risks associated with artificial nipple use.

Mothers' false beliefs and myths associated with teething.

BACKGROUND: Teething is a physiological process experienced by all children. However, many unrelated illnesses are blamed on teething. OBJECTIVE: The aim of this study was to assess mothers' beliefs toward teething and to investigate the practices preferred by mothers to alleviate symptoms that might accompany the teething process. METHODS: A cross-sectional study was conducted in Basra. The study population includes mothers of young children aged (6-30) months who had at least one erupted primary tooth, and who had no history of medical or systemic disease that might affect teething. Two hundred mothers of different age groups and educational backgrounds responded to a questionnaire that included information on the child's age and birth order, mother's age, level of education, occupation, number of children, beliefs toward teething symptoms, and the practices preferred to relieve the attributed symptoms. Data has been presented in numbers and percentages, the Chi-square test was performed where appropriate, and a p value of < 0.05 was considered significant. RESULTS: All (100%) participants attributed at least one symptom or sign to the teething process. The most common symptoms reported were fever (70%), diarrhea (68.5%), and sleep disturbance (63.5%). Sixty-eight percent of mothers believed teething remedies were effective; only 10 (5%) did not give any treatment. Over half (62%) gave medications, such as antipyretics, antibiotics, and antidiarrheal agents. Some used teething gels (29%), pacifiers (50%), gum massage (22%), and hard foods such as biscuits and carrots (43.5%). Mothers of various educational levels reported attributed symptoms, and the result was statistically significant (p < 0.05). Mothers of a firstborn child were found to have a higher tendency to attribute symptoms to teething than those who had previous experience with children (p < 0.05). DISCUSSION AND CONCLUSIONS: Teething myths and misconceptions are common among mothers. The study identified a significant number of doctors, dentists, and pharmacists still attribute many symptoms and signs to teething despite the lack of supporting evidence. Therefore, the findings of this study highlight the need for continuous medical education and nationwide prospective studies to eradicate these false beliefs.

Poor oral habits and malocclusions after usage of orthodontic pacifiers: an observational study on 3-5 years old children.

BACKGROUND: Pacifier sucking habit has been associated in the literature with alterations of dental occlusion, and it could be a predisposing factor for other poor oral habits among children. Orthodontic pacifiers have been introduced in the market aiming to reduce these disadvantages caused by the conventional type of pacifiers. The aim of this study was to evaluate the prevalence of poor oral habits and malocclusions, after usage of orthodontic pacifiers in children with primary dentition. METHODS: A sample of 198 pre-school children, aged 3-5 years, (96 males and 102 females) who had exclusively used an orthodontic pacifier were included in order to assess the level of poor oral habits and the absence/presence of dental malocclusion. Firstly, children's parents/legal guardians were given a validated questionnaire, then the children were clinically examined at a dental clinic. RESULTS: Most of the children (79.79%) had started using the orthodontic pacifier within the first 3 months of life, and the 43.49% of them continued using it over a period of 2 years. The recorded percentage for those who had used it throughout sleep was 89.39%. Mouth breathing during the night was reported for 36.04% of the children. Tongue thrust swallow affected 16.16% of the sample. The 5.56% of the data indicated the presence of fingersucking/thumbsucking habit. The noted percentages for children with lip biting, lingual interposition between teeth at rest and those with nail biting, were 5.56, 12.63 and 15.15%, respectively. The regression revealed a significant contribution between early start of using an orthodontic pacifier with the prevalence of fingersucking/thumbsucking (OR 0.13, 95% CI 0.04-0.47, p = 0.0004). This also reported a noticeable increase of the malocclusion prevalence among the female gender (OR 2.74, 95% CI 1.42-5.31), as well as those who were not exclusively breastfed (OR 2.26, 95% CI 1.17-4.37). CONCLUSIONS: Orthodontic pacifiers does not favor the development of poor oral habits, even if it has been used for a period of 2 years in children with primary dentition. Children who begin to use orthodontic pacifier between 0 and 3 months, are less likely to acquire fingersucking/thumbsucking habit. The use of an orthodontic pacifier appears not to be correlated with the prevalence of malocclusion in primary dentition, differently from what stated in literature about the conventional type of pacifier.

Pacifiers, Thumb Sucking, Breastfeeding, and Bottle Use: Oral Sucking Habits of Children with and without Phonological Impairment.

AIMS: The aim of this study was to describe the nutritive and non-nutritive oral sucking habits (breastfeeding, bottle use, pacifier/dummy/soother use, thumb/finger sucking) of preschoolers with and without phonological impairment, and to determine whether oral sucking habits are associated with the presence and severity of phonological impairment. METHODS: We conducted a cross-sectional study of 199 Australian English-speaking preschoolers with and without phonological impairment. Preschoolers' speech was directly assessed, and parents/caregivers completed a questionnaire. Chi-square (χ2) tests were used to examine relationships between oral sucking habits and the presence and severity of phonological impairment. RESULTS: Based on caregiver reports, 79.9% of participants had been breastfed (33.3% for >12 months), 58.3% had used a pacifier (74.2% for ≥12 months), 83.9% had used a bottle (73.4% for > 12 months), and 15.1% sucked their thumb/fingers. There was no association between a history of oral sucking and the presence and severity of phonological impairment. CONCLUSION: The majority of preschoolers had been breastfed and bottle-fed, and more than half had used a pacifier. The findings support an understanding that phonological impairment is not associated with a history of nutritive and non-nutritive sucking habits. Research is needed to examine the association between oral sucking habits and other types of speech sound disorders.

Pacifier use and interruption of exclusive breastfeeding: Systematic review and meta-analysis.

Identifying modifiable risk factor for exclusive breastfeeding (EBF) interruption is key for improving child health globally. There is no consensus about the effect of pacifier use on EBF interruption. Thus, the aim of this systematic review was to investigate the association between pacifier use and EBF interruption during the first six month. A search of CINAHL, Scopus, Web of Science, LILACS and Medline; from inception through 30 December 2014 without restriction of language yielded 1,866 publications (PROSPERO protocol CRD42014014527). Predetermined inclusion/exclusion criteria peer reviewed yielded 46 studies: two clinical trials, 20 longitudinal, and 24 cross-sectional studies. Meta-analysis was performed and meta-regression explored heterogeneity across studies. The pooled effect of the association between pacifier use and EBF interruption was 2.48 OR (95% CI = 2.16-2.85). Heterogeneity was explained by the study design (40.2%), followed by differences in the measurement and categorization of pacifier use, the methodological quality of the studies and the socio-economic context. Two RCT's with very limited external validity found a null association, but 44 observational studies, including 20 prospective cohort studies, did find a consistent association between pacifier use and risk of EBF interruption (OR = 2.28; 95% CI = 1.78-2.93). Our findings support the current WHO recommendation on pacifier use as it focuses on the risk of poor breastfeeding outcomes as a result of pacifier use. Future studies that take into account the risks and benefits of pacifier use are needed to clarify this recommendation.

Effect of a thin-neck pacifier on primary dentition: a randomized controlled trial.

OBJECTIVES: To evaluate changes in occlusal characteristics in the primary dentition that occur after introducing a thin-neck pacifier (TNP) to children with previously diagnosed pacifier-associated anterior open bite (AOB) and increased overjet. SETTING AND SAMPLE POPULATION: Department of Preventive and Pediatric Dentistry, Jena University Hospital, Germany. Subjects were 86 children (mean age 20.3 months) with a pacifier-associated open bite or overjet ≥2 mm. MATERIAL & METHODS: Randomized controlled trial. Subjects were randomly assigned: group I (n = 28), intervention group using a TNP; group II (n = 30), control group, using a conventional or physiological pacifier; and group III (n = 28), intervention group, Gold standard, weaned off pacifier. Participants were re-examined after 3, 6, 9 and 12 months by an operator, blinded for the treatment. RESULTS: After 12 months data for 63 children (mean age 33.1 months) were analyzed (I: n = 24; II: n = 22; III: n = 17). There was a significant difference between the groups regarding mean overjet (group I: 2.7 ± 0.5 mm, group II: 3.2 ± 0.7 mm, group III: 2.4 ± 0.5 mm, Kruskal-Wallis, p = 0.002) and AOB (group I: -1.2 ± 0.3 mm, group II: -2.2 ± 0.3 mm, group III: -0.8 ± 0.8 mm, Kruskal-Wallis, p < 0.001). The differences between group I and II regarding increased overjet (3.1 ± 0.2 mm vs. 3.6 ± 0.3 mm, Mann-Whitney, p < 0.001) and extent of AOB (-1.2 ± 0.3 mm vs. -2.2 ± 0.3 mm, Mann-Whitney, p < 0.001) were statistically significant. CONCLUSION: Use of TNP resulted in better clinical measurements for in overjet and overbite compared with the continuing use of conventional or physiological pacifiers.

In vitro antimicrobial effects of green tea, microwaving, cold boiled water, and chlorhexidine on Streptococcus mutans and Candida albicans on silicone pacifiers.

Background: This study aimed to compare the antimicrobial effects of green tea, microwaving, cold boiled water, and chlorhexidine (CHX) on Streptococcus mutans and Candida albicans on silicone pacifiers. Materials and Methods: In this in vitro experimental study, 60 equal-size samples of silicone pacifiers were cut, ultraviolet sterilized, and randomly divided into two groups (n = 30) for immersion in 0.5 McFarland standard suspension of S. mutans and C. albicans. The samples in each group were then randomly divided into five subgroups (n = 6) for disinfection with 0.12% CHX, cold boiled water, green tea, microwaving for 7 min, and distilled water. The sample suspensions were cultured on blood agar (for S. mutans) and Sabouraud dextrose agar (for C. albicans) and incubated. The number of colonies was counted after 24 and 48 h. Data were analyzed using the Kruskal-Wallis and Mann-Whitney tests (P < 0.05). Results: At 24 and 48 h, the S. mutans colony count was the lowest in CHX and green tea subgroups followed by microwave, cold boiled water, and distilled water subgroups (P < 0.05). Conclusion: CHX and green tea can significantly decrease the S. mutans and C. albicans colony count on silicone pacifiers.

Pacifier Use and Breastfeeding: A Qualitative Study of Postpartum Mothers.

Objective: Due to the inconclusive evidence supporting the traditional recommendation to avoid early pacifier use among breastfeeding newborns, this study aims to understand what information mothers are receiving from hospital based care providers and their perspectives about pacifier use in the newborn period. Methods: Interviews with mothers of healthy, term newborns during the postpartum hospitalization were conducted in this qualitative study. Results: Qualitative data analysis yielded several major themes that included the following: (1) pacifiers are beneficial for the maternal/infant experience, (2) concerns that pacifiers may interfere with breastfeeding, and (3) concerns about long-term use (including reliance and effect on teeth). Conclusion: Given the maternal perception of benefit and the paucity of high-quality evidence showing harm, further research on the effects of early pacifier use is needed.

Frequency and Predictors of Pacifier Use in the Low Socioeconomic Group of Karachi, Pakistan: A Cross-Sectional Study.

Background Pacifier use has been popular for ages. They are prevalent all over the world because of their various perceived benefits. On the other hand, there is a common belief that they do carry health risks as well. Due to these contradicting belief systems, the frequency of their use, and the factors that determine them, need to be thoroughly evaluated. Since Pakistan is a developing country with a low literacy rate, it can be implied that a vast majority of the country's population may lack awareness regarding the advantages and disadvantages of pacifier use, making them incapable of weighing associated risks versus benefits. The data evaluating these factors in this region are however scarce in the published literature. We, therefore, aimed to highlight the frequency and predictors of pacifier use in the low socioeconomic group of Karachi, Pakistan. Materials and methods A descriptive, cross-sectional study was conducted on a sample of 300 mothers visiting a tertiary care hospital in Karachi, Pakistan. We included mothers who had at least one child under the age of two years, and whose child did not have any oro-nasal anomaly that could prevent them from sucking a pacifier. Data were collected using pre-tested questionnaires and analyzed using the Statistical Package for Social Sciences (SPSS version 23.0, IBM Corp., Armonk, NY, US). Frequencies were calculated and presented in the form of tables. The chi-square test was used to determine the significance of all categorical variables. A P-value of <0.05 was considered to be statistically significant. Results Almost half of our respondents (49%) gave pacifiers to their children. A significant number (59%) of these mothers were uneducated. Almost all (97%) of the users had annual household income less than 15,000 Pakistani rupees (PKR); 34% were primiparous and more than two-thirds (71%) had a normal vaginal delivery. Out of all the factors, maternal age less than 20, annual household income less than 15,000 PKR, and primiparity were significantly associated with pacifier use in mothers (P<0.05). Only a half of the users (51%) cleaned the pacifiers by boiling; one-fourth (25%) washed it with water only; while 18% washed it with soap and water. The majority (84%) of the mothers used the pacifier to soothe the baby when upset. Among mothers who did not use a pacifier, about a third (30%) did not do so as they believed it's a bad practice. About one-fourth (27%) believed it was unhygienic. Conclusions Our study highlights the gap in the awareness of mothers regarding pacifier use. Using this data, we can target to disseminate specific information to this population to integrate safe and healthy child care habits in society.

Exclusive breast-feeding is associated with reduced pacifier sucking in children: Breast-feeding and pacifier-sucking habit.

BACKGROUND: Studies suggest that when children do not achieve the emotional satiety and adequate stimulus provided by breast-feeding, they exhibit sucking behaviors. This study aimed to estimate the association from 4 through 6 months of exclusive breast-feeding (EB) postpartum and pacifier-sucking behavior at 12 months of life. METHODS: A cohort study was conducted with 1,037 infants, born alive and monitored up to 12 months. At 4 and 6 months after birth, the children were classified according to the type of breast-feeding they had received: exclusive, predominant, complementary, or none. The prevalence of pacifier-sucking behavior was calculated, and the association between the 2 events was estimated. Mothers' socioeconomic-demographic characteristics, delivery features, and prenatal care, as well as the biological characteristics of the children, were determined. Relative risk (RR) and 95% confidence intervals (95% CI) were calculated. RESULTS: In comparison with EB infants, the RR of pacifier-sucking behavior at 12 months of life was higher in children receiving complementary breast-feeding or no breast-feeding for both 4 months (RRadjusted, 1.68 [95% CI, 1.39 to 2.02] and RRadjusted, 2.67 [95% CI, 2.24 to 3.17], respectively) and 6 months (RRadjusted, 1.43 [95% CI, 1.03 to 2.00] and RRadjusted, 3.30 [95% CI, 2.40 to 4.54], respectively). CONCLUSIONS AND PRACTICAL IMPLICATIONS: EB for 6 months postpartum is associated with reduced pacifier-sucking behavior, adjusted for maternal color, number of prenatal consultations, and family income. Promotion of EB may reduce the use of pacifiers and their potential deleterious effects on oral health. Dental health care professionals should consider discussing the importance of breast-feeding with their patients with regard to the possible development of sucking habits in their children.

Recommendations from Pediatric and Pediatric Dentistry Associations of the Americas Regarding Pacifier Use

ABSTRACT Objective: To identify online recommendations from pediatric and pediatric dentistry associations of the Americas regarding the pacifier habit. Material and Methods: A search was conducted on the associations' website (November/2021 to March/2023) to the questions: (1) Recommend using a pacifier?, (2) What care?, (3) Advantages and (4) disadvantages, (5) Ideal age, and (6) methods for habit removal. Results: Among the 36 American countries, 21 were represented on websites, social media, and official guides. The most significant portion of pediatric dentistry associations (23.81%) does not recommend the use of a pacifier if the infant is exclusively breastfeeding, and recommends avoiding the offer of a pacifier in the first days of life to facilitate the establishment of breastfeeding. Some pediatric (29.63%) associations suggested that use reduces the risk of sudden infant death syndrome. Most pediatric dentistry associations (85.71%) and some pediatric associations (22.22%) linked pacifier use to breastfeeding difficulties and the occurrence of orthodontics. Most of the 20 pediatric dentistry associations stated that the habit should be removed by a maximum of three years of age (90.48%). The most reported recommendations were behavior modification techniques and positive reinforcement. Conclusion: Most pediatric dentistry associations recommend the care and disadvantages of pacifiers and the ideal age to remove them. The few pediatric associations that provide information address indications, care, advantages and disadvantages of pacifiers, age, and methods for removing them.

Factors in the Hospital Experience Associated with Postpartum Breastfeeding Success.

Introduction: Hospitals are in a unique position to promote, protect, and support breastfeeding. However, the association between in-hospital events and breastfeeding success within population-based samples has not been well studied. Materials and Methods: A stratified (by education and birth weight) systematic sample of 5,770 mothers taking part in the Utah Pregnancy Risk Assessment Monitoring System, 2012-2015, were included. Mothers, 2-4 months postpartum, completed the 82-item questionnaire, including if they had ever breastfed their new baby, and if so, current breastfeeding status. Relationships between in-hospital experiences and breastfeeding termination and duration were evaluated via Poisson and Cox proportional hazard regression models, respectively, adjusting for other in-hospital experiences, maternal age, race/ethnicity, maternal education, marital status, smoking, physical activity, delivery method, pregnancy complications, and length of hospital stay. Results: Of all, 94.4% of mothers self-reported breastfeeding initiation, of whom 18.8% had breastfed <2 months, having breastfed on average 3.2 weeks (standard error: 0.07). In fully adjusted models, mothers who reported receiving a pacifier, receiving formula, or had staff help them learn how to breastfeed had a higher prevalence of terminating breastfeeding before 2 months (adjusted prevalence ratio [aPR] = 1.13, 95% confidence interval [CI]: 0.97-1.32; aPR = 1.20, 95% CI: 1.07-1.36; and aPR = 1.25, 95% CI: 1.08-1.34). Conversely, mothers who reported starting and feeding only breast milk in the hospital and receiving a phone number to call for help with breastfeeding had a lower prevalence of breastfeeding termination before 2 months (aPR = 0.72, 95% CI: 0.61-0.86; aPR = 0.57, 95% CI: 0.51-0.64; and aPR = 0.91, 95% CI: 0.80-1.03). Adjusted Cox models showed similar direction of associations. Conclusions: Encouraging mothers to exclusively breastfeed in the hospital, and reducing gift packs containing pacifiers and formula, may be key areas United States hospitals can focus on to increase breastfeeding success. Prospective assessment in other geographical regions is needed to corroborate these findings.

Maternal breastfeeding: indicators and factors associated with exclusive breastfeeding in a subnormal urban cluster assisted by the Family Health Strategy.

OBJECTIVE: To describe and analyze indicators of feeding practices related to breastfeeding and factors associated with exclusive breastfeeding (EBF) in a subnormal urban cluster (slums) in Pernambuco, Brazil. METHODS: Four breastfeeding indicators were used to interview mothers of children under 3 years of age. An inventory of the families' socioeconomic and environmental factors, maternal obstetric history, and basic health care access was undertaken. The sample consisted of all 310 children under the age of 3 years from Coelhos, PE, Brazil. Spearman's correlation was carried out, as well as crude and adjusted prevalence ratios for a final statistical model that showed associated factors with the main outcome at a level of 0.05. RESULTS: The prevalence of breastfeeding in the first hour of life, exclusive breastfeeding up to 6 months, continued breastfeeding at 1 year, and continued breastfeeding at 2 years were 60.2%, 32.9%, 45.9, and 35.9%, respectively. A correlation was observed between start of pacifier use and duration of either exclusive (rs=0.358 [p<0.001]) or non-exclusive breastfeeding (rs=0.248 [p=0.006]). Maternal age over 35 years (p<0.001), home visit in the first week after birth (p=0.003), having had a male baby (p=0.029), and not using a pacifier (p<0.001) remained protective factors in the final model. CONCLUSION: The prevalence rates of exclusive breastfeeding at 6 months were well above the results obtained by other Brazilian authors. Home visit and maternal age prevailed as protective factors, while pacifier use was shown to be a discouraging practice.

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.

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.

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)