Childcare Consultations Research Articles

Avaliação dos indicadores em saúde das crianças acompanhadas pela pastoral da criança

Objetivo: Este estudo objetivou avaliar o perfil de atendimento das crianças acompanhadas pela Pastoral da Criança da cidade de Lajes Pintadas, estado do Rio Grande do Norte. Métodos: Trata-se de um estudo exploratório-descritivo, de cunho transversal e de abordagem quantitativa. Os dados foram coletados no período de junho a agosto de 2013, com uma amostra de 53 mães de crianças menores de cinco anos, cadastradas na Pastoral da Criança. Resultados: Observou-se que 100% das crianças estão com as vacinas atualizadas; enquanto 79,3% apontam que as crianças sempre comparecem à consulta C e D. Conclusão: Conclui-se que a Pastoral da Criança contribui para que as crianças acompanhadas tenham mais qualidade de vida e saúde, considerando que colaboram para a prevenção de doenças incentivando às consultas de C e D, além da procura por serviços de saúde.

Impact of influenza vaccine on childhood otitis media in Taiwan: A population-based study.

PurposeAcute otitis media (AOM) is a common infectious disease in children and usually accompanied by a preceding viral respiratory tract infection, especially in the preschool-age population. The study aimed to evaluate impact of influenza vaccine on childhood otitis media.MethodsThis retrospective cohort study included data for 803,592 children (<10 years old) recorded in Taiwan’s National Health Insurance Research Database. AOM incidence and tympanostomy tube insertion incidence in each influenza season before and after the introduction of traditional injectable trivalent influenza vaccine (TIV) were compared using the Poisson regression analysis to estimate the incidence rate ratios (IRRs) and 95% confidence intervals (CIs).ResultsIn children < 2 years old, the age group eligible for free influenza vaccination, there was a significant reduction in seasonal AOM incidence after TIV introduction in 2004 (from 98.4 episodes/1000 person-seasons [95% CI: 96.4–100.5] to 66.1 episodes/1000 person-seasons [95% CI: 64–68.1]). In addition, with the increased vaccine coverage rate, the outpatient visits for AOM in the influenza season of 2005 and 2006 were significantly lower than that in 2004 (IRR = 0.85 and 0.80, respectively, p < 0.0001).ConclusionsA significant reduction in primary care consultations for children <2 years old was observed after the introduction of the TIV in Taiwan in 2004. With the increased vaccine coverage, there was an additional decline in 2005 and 2006. In addition of the direct protection provided by the vaccination, we believe that TIV may have induced some herd immunity that further contributed to the reduction in influenza attack rates and the rates of associated AOM in that age group. These reductions were observed only in vaccine-eligible children, while older children, who were not enrolled in the influenza vaccination program during the study period, have experienced increases in the AOM incidence during the 2004–2006 period compared to the 2000–2003 period.

A Study on Child Care Consulting Efficiency Plans of Child Care Centers for Children with Disabilities - Focusing on Perceptions and Needs of Child Care Staff

본 연구는 장애아전문 어린이집 보육컨설팅에 대한 원장, 특수교사, 보육교사, 치료사의 인식과 요구, 컨설턴트의 역할과 자질에 대한 요구를 알아보고 분석하여 구체적이고 실효성 있는 장애아전문 보육컨설턴트를 양성하고 보육컨설팅을 현장에 알맞게 적용하기 위해 실시하였다. 이를 위해 서울, 경기, 인천지역의 장애아전문 어린이집에 근무하는 309명의 보육교직원을 대상으로 설문조사를 실시하였고 보육컨설팅에 대한 보육교직원의 인식을 알아보기 위해 빈도와 백분율을 산출하고 교차분석을 실시하였으며, 보육컨설팅에 대한 보육교직원의 요구를 알아보기 위해 빈도와 백분율을 순위별로 산출하였다. 또한, 장애아전문 보육컨설턴트에 대한 요구를 알아보기 위해 빈도와 백분율을 순위별로 산출하였다. 이에 따른 연구 결과는 첫째, 보 육컨설팅에 대한 인식은 갖추고 있으나 컨설팅에 대한 개념을 확립하고 있지는 못하다. 둘째, 보육컨설팅은 1년 단위로 실시하고 학기 초에 어린이집과 보건복지부, 지자체가 부담하여 개별화보육계획안 작성 방법, 수업 방법 및 기술 등의 내용으로 진행하고 간단히 온라인으로 보고하는 형식을 요구하였다. 셋째, 장애아전문 컨설턴트에 대한 요구는 10년 이상의 외부 초빙 원장이나 교사로 장애아보육에 관한 전반적 지식, 통합적 관점의 분석 및 진단 능력, 교직원을 존중하고 경청하는 태도를 지니고 장애아보육(치료)활동 전반을 이해하는 사람을 요구하였다. 본 연구 결과는 장애아전문 어린이집 보육교직원들의 보육컨설팅에 대한 방향성을 제시하고, 현장에 알맞은 보육컨설턴트를 양성하는데 기여하고 장애아전문 어린이집 보육컨설팅에 대 한 자료로 활용할 수 있다는 데 의의가 있다.This study was conducted to cultivate specific and practical child care consultants for children with disabilities and apply child care consulting to child care centers for children with disabilities properly by examining and analyzing principals, special education teachers, child care teachers and therapists’ perceptions of and needs for child care consulting of child care centers for children with disabilities. For achieving the study purpose, a survey was conducted targeting 309 child care staff working in child care centers for children with disabilities in Seoul, Gyeonggi and Incheon. In order to examine child care staff’s perceptions of child care consulting, frequencies and percentages were calculated and for looking into child care staff’s needs for child care consulting, frequencies and percentages were calculated by rank. Also, frequencies and percentages were calculated by rank as well to investigate their needs for child care consultants for children with disabilities. The study findings are as follows. First, although the subjects had the perception of child care consulting, the concept of child care consulting was not established. Second, the subjects wanted child care consulting to be implemented yearly and demanded to report the methods of drawing up individualized child care plans, the methods of teaching and child care skills briefly online, with the support of child care centesr, the Ministry of Health and Welfare and local governments in the beginning of the semester. Third, in relation to the needs for consultants for children with disabilities, the subjects needed visiting principals or teachers of ten years’ experience or over, who have general knowledge of disabled child care, capabilities to analyze and diagnose from an integrated perspective, respect and listen carefully to teaching staff and understand overall disabled child care(treatment) activities. This study has significance by suggesting the direction of child care consulting of child care staff at child care centers for children with disabilities, contributing to cultivating child care consultants that fit into the field of special education and care for children with disabilities and providing data for child care consulting of child care centers for children with disabilities.

Adrenocortical tumors associated with the TP53 p.R337H germline mutation can be identified during child-care consultations

ObjectiveTo evaluate the clinical features associated with adrenocortical hormone overexpression and familial cancer profiling as potential markers for early detection of adrenocortical tumors in children from South and Southeast Brazil. MethodsThe clinical manifestations and anthropometric measurements of 103 children diagnosed with adrenocortical tumors were analyzed. ResultsBetween 1982 and 2011, 69 girls and 34 boys diagnosed with adrenocortical tumors were followed-up for a median time of 9.0 years (0–34 years). Signs of androgen overproduction alone (n=75) or associated with cortisol (n=18) were present in 90.3%. TP53 p.R337H mutation was found in 90.5% of patients. Stages I, II, III, and IV were observed in 45.6%, 27.2%, 19.4%, and 7.8% of patients, respectively. At diagnosis, there were no significant differences in height (p=0.92) and weight (p=0.22) among children with adrenocortical tumors, but children with virilization alone had significantly higher height-for-age Z-scores (0.92±1.4) than children with hypercortisolism alone or combined (−0.32±1,8; p=0.03). The five-year overall survival was 76.7% (SD±4.2). Patients with advanced-stage disease had a significantly worse prognosis than those with limited disease (p<0.001). During follow-up, ten of 55 p.R337H carrier parents developed cancer, whereas none of the 55 non-carriers did. ConclusionsSigns of adrenocortical hormone overproduction appear early, even in cases with early-stage. These signs can be identified at the physical examination and anthropometric measurements. In southern Brazil, pediatric adrenocortical tumor is a sentinel cancer for detecting families with germline p.R337H mutation in TP53 gene.

Maternal perception of their child's nutritional status at less than three years old.

Assessing maternal perception of their children's nutritional status and identifying associated factors. A cross-sectional study conducted in a small municipality with 342 children less than 3 years of age treated in Basic Health Units of São Paulo. Nutritional status was classified in percentiles of body mass index for age and maternal perception was assessed using the scale of verbal descriptors (very thin, thin, healthy weight, fat, very fat). Logistic regression was used to identify the associatedfactors. 44.7% of maternal perception was found to beinadequate. Mothers of overweight (OR = 11.8, 95% CI: 6.4-21.7) and underweight (OR = 5.5; 95% CI: 1.9-16.2) children had a higher chance of having inadequate perception, similar to mothers of children over 24 months of age (OR = 2.9; 95% CI: 1.4-6.0). For effective child care in primary care, healthcare professionals should consider maternal perception and helpmothers to identify the nutritional status of children in childcare consultations and growth monitoring. Avaliar a percepção materna do estado nutricional do filho e identificar os fatores associados. Estudo transversal realizado em município de pequeno porte com 342 crianças menores de 3anos atendidas em Unidades Básicas de Saúde do Estado de São Paulo. O estado nutricional foi classificado em percentis do Índice de Massa Corporalpara Idade e a percepção materna foi avaliada com escala de descritores verbais (muito magro, magro, peso adequado, gordo, muito gordo). Utilizou-se de regressão logística para identificar os fatores associados. Constatou-se 44,7% de percepção materna inadequada. Mães de crianças com excesso de peso (OR=11,8; IC95%:6,4-21,7) e com baixo peso (OR=5,5; IC95%:1,9-16,2) apresentaram mais chance de percepção inadequada, da mesma forma que mães de crianças com mais de 24 meses de idade (OR=2,9; IC95%:1,4-6,0). Para uma efetiva assistência à criança na atenção básica, profissionais de saúde devem considerar a percepção materna e auxiliar as mães na identificação do estado nutricional do filho nas consultas de puericultura e acompanhamento do crescimento.

Biopolitics and boredom in the waiting room. On the power of being bored in the context of preventive family support

ABSTRACTIn this article, we take a concrete case study as a starting point for a reflection on preventive family support. More specifically, we conducted fieldwork in the setting of a waiting room of a childcare consultation office for parents with young children. The writings of the philosopher Giorgio Agamben allowed us to come to an alternative understanding of both the room as such and the behaviors of adults and children in this room. This article can be read as the result of an experiment with fieldwork in philosophy of education: an attempt to enrich Agamben’s philosophical account of biopolitics with an everyday example as well as an attempt to reread what actually happens in the case we have studied from an Agambenian perspective.

Development of a Nursing protocol for childcare consultations

Objective: to present a Nursing protocol for childcare consultations based on the Nursing Model of Roper-Logan-Tierney.Methods: for its development, the following items were carried out: literature review, selection and reading of materialsconsidered important in the area of children’s health. Results: it was carry out the textual development of the protocoldivided into five chapters, according to milestones of the infant’s growth and development; inclusion of variables –protocol questions, separated according to life activities recommended in the Nursing model; and content evaluation bynine investigators using the Content Validity Index, with most items presenting an index greater than 0.80. Conclusion:the produced protocol is relevant to support childcare Nursing consultations, enabling standardized directed care andcomprehensive care of children’s health in their first months of life.

Implantação da puericultura e desafios do cuidado na estratégia saúde da família em um município do estado do Ceará

Objective: To report the experience of childcare implementation and care challenges in the Family Health Strategy in a city of the Ceara state. Data synthesis: Experience report study with a descriptive, qualitative approach, developed within one the Primary Health Care Units in the city of Aracati, Ceara. The report systematization was carried out from the records made in a field diary by a nurse resident, in the period between the months of June 2013 and April 2015. With the implementation of the childcare consultation, one can realize the importance of conducting a systematic follow-up since the prenatal period, including the puerperium and reaching the main focus of this study, the child’s health. It highlights the contribution of the Family Health Support Center in the consultations and the use of simple technologies favoring the interaction between professionals, community and health services. Additionally, some weaknesses of the work process had to be overcome, such as: structural barriers; lack of commitment on the part of some professionals; divergences of conducts; unmotivated professionals due to work overload and shortage of training courses offered for qualification of the health team. Conclusion: The task is not easy, the challenges are ongoing, but the benefits can be greater and more rewarding than any experienced difficulty. It is hoped that this report can promote critical thinking about the work that has been produced within the Family Health Strategy.

Analysis of vaccination status of preschool children in Teresina (PI), Brazil.

Immunization is a priority action of the Ministry of Health for contributing to reducing child mortality; however, studies show increased vaccination delays and non-vaccination. This study aims to analyze the immunization status of preschool children in Teresina - PI. Cross-sectional study involving 542 children, aged 2-6 years, enrolled in local public schools in four Municipal Childhood Education Centers selected at random, following the proportional division by regions of the city. Data were collected through a pre-coded and pre-tested form, in addition to scanning the children's vaccination card. For univariate descriptive statistical analysis, Pearson's χ2 Test and Fisher's Exact Test were used, and for multivariate analysis, multiple logistic regression was conducted using SPSS version 17.0. The study complied with the ethical aspects in accordance with current legislation. The frequency of delayed vaccination/non-vaccination was 24.9%. The average of non-administered vaccines was 1.7 (SD ± 1.2) and of delayed vaccines was 3.3 (SD ± 1.6). The binomial logistic regression model showed a significant association (p < 0.05) between young caregivers (under 24 years) and low frequency in childcare consultations with delayed vaccination/non-vaccination. There was no association with the variables related to the experience of children in the vaccination room and with the implementation of the Family Health Strategy. Ensuring and strengthening primary healthcare actions are essential tools to reduce non-vaccination and vaccine delays. Professionals who care for children in vaccination rooms need to sensitize themselves to guide and encourage parents/caregivers to meet the vaccination schedules without delays or errors.

Review of Themes and Recommendations Encountered in Palliative Care Consults with Pediatric Dialysis Patients (S751)

Objectives Understand the complexities of providing recommendations for the pediatric dialysis population. Recognize common symptoms in the pediatric dialysis population. Original Research Background. End stage renal disease (ESRD) requiring dialysis is frequently lifelimiting in children. Mortality rates are approximately 30 times that of the general population, although they are decreasing as available therapies improve. Pediatric palliative care services have been used occasionally in this population; however, there is scant literature available on whether patients with consultations by a designated pediatric palliative care service have common themes to their recommendations or interventions. Research Objectives. The goal of this research was to better characterize palliative care team involvement with this specific population. Methods. The retrospective study reviewed pediatric palliative care consultations for children with ESRD undergoing dialysis from 1/2006-12/2012. Quantitative data regarding patient was collected and impressions from the initial consultation were compiled. Consults were de-identified and re-analyzed for additional underlying themes using consensus coding. Results. Chart review included thirty-seven patients aged 5 weeks through 18 years; seven patients were excluded after initial review. Eligible patients were on chronic hemodialysis, peritoneal dialysis, or acute hemodialysis. Of the standard palliative care metrics identified by the consultation team, the most common was ‘‘complex or time-intensive communication and/or interdisciplinary psychosocial support’’ (65% of consults), followed by ‘‘information/education regarding palliative care and hospice philosophies’’ (59%) and ‘‘clarification of goals and assistance with difficult decision-making’’ and ‘‘resources/transitions,’’ both 41% of consults. More than 50% of patients requiring improved communication with healthcare providers. Specific symptom management recommendations were also detailed, identifying pain (32%), poor sleep (24%), fatigue (27%), and poor appetite (27%). Conclusions. This study demonstrates a retrospective review of one institution’s experience with pediatric end-stage-renal disease patients. Themes addressed during consultation are highlighted to assist palliative care providers and nephrologists in assessing and developing tools for intervention in this patient population. Implications for Research, Policy, or Practice. This study demonstrates important themes for practitioners who deal with this population to address.

A Systematic Review of Informal Caregiver Responses to Pain in Patients with Advanced Illness (S752)

Objectives Understand the complexities of providing recommendations for the pediatric dialysis population. Recognize common symptoms in the pediatric dialysis population. Original Research Background. End stage renal disease (ESRD) requiring dialysis is frequently lifelimiting in children. Mortality rates are approximately 30 times that of the general population, although they are decreasing as available therapies improve. Pediatric palliative care services have been used occasionally in this population; however, there is scant literature available on whether patients with consultations by a designated pediatric palliative care service have common themes to their recommendations or interventions. Research Objectives. The goal of this research was to better characterize palliative care team involvement with this specific population. Methods. The retrospective study reviewed pediatric palliative care consultations for children with ESRD undergoing dialysis from 1/2006-12/2012. Quantitative data regarding patient was collected and impressions from the initial consultation were compiled. Consults were de-identified and re-analyzed for additional underlying themes using consensus coding. Results. Chart review included thirty-seven patients aged 5 weeks through 18 years; seven patients were excluded after initial review. Eligible patients were on chronic hemodialysis, peritoneal dialysis, or acute hemodialysis. Of the standard palliative care metrics identified by the consultation team, the most common was ‘‘complex or time-intensive communication and/or interdisciplinary psychosocial support’’ (65% of consults), followed by ‘‘information/education regarding palliative care and hospice philosophies’’ (59%) and ‘‘clarification of goals and assistance with difficult decision-making’’ and ‘‘resources/transitions,’’ both 41% of consults. More than 50% of patients requiring improved communication with healthcare providers. Specific symptom management recommendations were also detailed, identifying pain (32%), poor sleep (24%), fatigue (27%), and poor appetite (27%). Conclusions. This study demonstrates a retrospective review of one institution’s experience with pediatric end-stage-renal disease patients. Themes addressed during consultation are highlighted to assist palliative care providers and nephrologists in assessing and developing tools for intervention in this patient population. Implications for Research, Policy, or Practice. This study demonstrates important themes for practitioners who deal with this population to address.

Training of Child-care Workers to Act as Child-Care Consultants in Supporting

Training of Child-care Workers to Act as Child-Care Consultants in Supporting

「母親の心の健康チェックシート」を用いた育児相談による働きかけの対応

「母親の心の健康チェックシート」を用いた育児相談による働きかけの対応

Consulta de enfermagem em puericultura: um enfoque nos registros de atendimentos

Aim: to analyze the child care provided by nurses, identifying strengths and limitations. Method: documentary, descriptive-exploratory and quantitative study, with data collection in February 2012 with 46 medical records of children seen by the nurse in child care consultation in a health center of a city in Parana; the data were analyzed by descriptive statistics. Results: only 17% of children initiated the child care in their first month of life; 32% were seen with irregular frequency; concerning the data recorded in the medical record, 100 % had weight record; 89% height and head circumference records; 98% type of food; only one had record of neuropsychomotor development; 100% did not have record of thoracic and abdominal circumference, and vaccination. Conclusions: the child care has the potential to promote health and prevent injuries to children. As limitations, it was noticed the care based on spontaneous demand and curativism, lack of records and analysis of collected data, compromising the quality of child care.

How communication affects prescription decisions in consultations for acute illness in children: a systematic review and meta-ethnography

BackgroundCommunication within primary care consultations for children with acute illness can be problematic for parents and clinicians, with potential misunderstandings contributing to over–prescription of antibiotics. This review aimed to synthesise the evidence in relation to communication and decision making in consultations for children with common acute illness.MethodsA systematic search of MEDLINE, EMBASE, CINAHL, PsycINFO, SSCI, SIGLE, Dissertation Express and NHS economic evaluation databases was conducted. Studies of primary care settings in high income countries which made direct observations of consultations and reported qualitative data were included. Included studies were appraised using the process recommended by the Cochrane Qualitative Methods Group. Credibility was assessed as high for most studies but transferability was usually assessed low or unclear. Data were synthesised using a meta–ethnographic approach.ResultsThirty–five papers and 2 theses reporting on 13 studies were included, 7 of these focussed on children with respiratory tract infections (RTI) and the remaining 6 included children with any presenting illness. Parent communication focussed on their concerns and information needs, whereas clinician communication focussed on diagnosis and treatment decisions. During information exchanges, parents often sought to justify the need for the consultation, while clinicians frequently used problem minimising language, resulting in parents and clinicians sometimes talking at cross–purposes. In the context of RTIs, a range of parent communication behaviours were interpreted by clinicians as indicating an expectation for antibiotics; however, most were ambiguous and could also be interpreted as raising concerns or requests for further information. The perceived expectation for antibiotics often changed clinician decision making into clinician–parent negotiation.ConclusionsMisunderstandings occurred due to parents and clinicians talking at cross purposes about the ‘seriousness’ of the illness and because parents’ expressions of concern or requests for additional information were sometimes perceived as a challenge to the clinicians’ diagnosis or treatment decision. This modifiable problem may be an important contribution to the unnecessary and unwanted prescribing of antibiotics. Primary care clinicians should be offered training to understand parent communication primarily as expressions of concern or attempts at understanding and always to check rather than infer parental expectations.

Promoting health: action in infant nutrition

Thousands of children under five die from preventable diseases. Community interventions that emphasize primary care on health and nutrition have been identified as one of the solutions to overcome this problem. This study aimed to develop educational workshops to improve the perception of mothers about infant nutrition, using a qualitative approach with technical educational workshops, in a Health Unit of the City of Fortaleza, during the period from February to June 2008. The seven participants were mothers accompanying their children in childcare consultation. The analysis of data was made through a survey and saturation of responses, from where the thematic categories emerged: the contribution of educational workshops, breastfeeding and introduction of complementary feeding. The educational activities allowed a better awareness of mothers in relation to child nutrition and development of critical awareness of their essential role on children nutrition. In conclusion, the professional should emphasize the importance and benefits of adequate diet, and for this is necessary educational strategies in health, offering exchanges of knowledge, since they are different experiences in which the learning is significant.

Child care consultations held by nurses within the Family Health Strategy

The study aimed at identifying initiatives taken by nurses during child care routine visits in Family Health Units. It is an observational, descriptive and quantitative research. Data collection took place from August to October 2011, through the observation of three consultations carried out by eight nurses (24 appointments) for the Family Health Strategy Scheme in Picos - Piauí. During consultations, the following issues were more frequently observed: anthropometry, reflexes according to age, encouraging of exclusive breastfeeding and advice on child hygiene. The need for further nurse training through continuous education was verified, seeking to improve care in order to contribute to the improvement of nursing care quality focused on promoting child health thru childcare consultations.

Receptiveness to the teenager in nursing consultation - a qualitative study

Aim: To understand the relationship of nurses with the teenage mother in childcare consultation under the approach of the receptiveness. Method: A qualitative study was conducted from February to May 2011 in a Family Health Basic Unit of Fortaleza-CE, using systematic observation and semi-structured interview. Attended by five nurses and three teenage mothers who accompanied their children on this service. The information gathered from the interviews was subjected to content analysis from Bardin, from which emerged the categories: Receptiveness and listening; Reception ambience. Results: The receptiveness for the subject brings the significance of listening, responsiveness and includes forms of service organization engaging nurses. Discussion: The receptiveness, listening and reception ambience are important aspects of attention. Conclusion: Listening is a tool that nurses use to realize the receptiveness to the teenage mother to da �; dЂ�q�.

Records of childcare in primary care: descriptive study

Aim: To investigate, in the records of medical charts, how to perform childcare by the teams of the Family Health Strategy, working at a Basic Health Unit in Maringá, Paraná. Method: Data were collected in January 2011, from the consultation of medical records of 181 children born between July 2008 and January 2010, in which relevant data were observed of the children monitoring during the first year of life. Results: The nurse was responsible for 51.9% of child consultations. It was further observed that the rate of unfilled medical charts in several fields was high. Discussion: The number of childcare consultations made by nurses demonstrates its importance in monitoring the health of children. Final considerations: It is believed that the implementation of a standard form to record the child consultations should minimize the under-reporting of the monitoring activities of the children, by facilitating and systematizing annotations

Health promotion of the triad mother-child and family and the nursing diagnosis of ineffective breastfeeding in childcare consultation

ABSTRACTObjective: to describe the socio-demographic and clinical factors that interfere with the satisfactory practice of breastfeeding in seven triads (mother-child and family) assisted in childcare consultation. Method: qualitative study, of the case study type carried out in April 2009, with seven triad (mother-child and family) assisted in childcare consultation with the maximum age of six months and registered in the unit, through interviews with questions based on defining characteristics and factors related to the Nursing Diagnosis "Ineffective Breastfeeding", observation and verification of prenatal card and of child. The analysis was performed through study and transcription of the answers in the form of cases, later the set of common and divergent characteristics presented by the triad was discussed based on the existing literature. The study was approved by the Ethics Committee of the Federal University of Ceara, with protocol number 36/09. Results: it was verified a higher frequency of conditions related to the incorrect attachment, anomaly of mother's breast, inadequate emptying of breast and knowledge deficit. Conclusion: it was noticed insufficient approach on breastfeeding during prenatal care, a fact that highlights the need to promote this practice seeking the adherence and maintenance of effective breastfeeding. Descriptors: nursing; breastfeeding; nursing diagnosis.RESUMOObjetivo: descrever os fatores sociodemográficos e clínicos que interferem na prática satisfatória da amamentação. Método: estudo qualitativo, no formato de estudo de caso, realizado em abril de 2009, junto a sete trinômios (mãe-filho e família) atendidos em consulta de puericultura, com idade máxima dos lactentes de seis meses e cadastro na unidade, por meio de entrevista com questões baseadas nas características definidoras e fatores relacionados ao Diagnóstico de Enfermagem “Amamentação Ineficaz”, observação e verificação do cartão do pré-natal e da criança. A análise foi realizada por meio de estudo e transcrição das respostas em forma de casos, posteriormente, o conjunto de características comuns e divergentes apresentado pelos trinômios foi discutido à luz da literatura existente. O estudo foi aprovado pelo Comitê de Ética da Universidade Federal do Ceará, número de protocolo n°36/09. Resultados: observou-se maior frequência de condições relacionadas à pega inadequada, à anomalia do peito materno, ao esvaziamento insuficiente da mama e ao déficit de conhecimento. Conclusão: percebeu-se abordagem insuficiente sobre aleitamento materno no pré-natal, fato que evidencia a necessidade da promoção desta prática com vistas à adesão e manutenção da amamentação eficaz. Descritores: enfermagem; aleitamento materno; diagnóstico de enfermagem. RESUMENObjetivo: describir los factores sociodemográficos y clínicos que interfieren en la práctica de la lactancia materna satisfactoria con siete tríada (madre-niño y familia) atendidos en consulta de puericultura. Método: estudio cualitativo realizado, estudio de caso, realizado en abril/2009, con siete trinomios (madre-hijo y familia) atendidos en consulta de puericultura, con edad máxima de seis meses de los bebés y registro en la unidad, a través de entrevistas con preguntas basadas en las características definidoras y en los factores relacionados al Diagnóstico de Enfermería "Lactancia materna ineficaz", observación y verificación del cartón del prenatal y del niño. El análisis se realizó mediante estudio y transcrición de las respuestas en forma de casos, después, el conjunto de características comunes y divergentes presentado por el trinomio fue discutido a la luz de la literatura existente. El estudio fue aprobado por el Comité de Ética de la Universidad Federal del Ceará, bajo número de protocolo 36/09. Resultados: Se observó una mayor frecuencia de condiciones relacionadas con la pega incorrecta, anomalía del pecho materno, vaciamiento insuficiente de la mama y déficit de conocimiento. Conclusión: se percibió enfoque insuficiente acerca de la lactancia durante la atención prenatal, hecho que pone de relieve la necesidad de promover esta práctica para el mantenimiento de la adhesión y eficacia de la lactancia materna. Descriptores: enfermería; lactancia materna; diagnóstico de enfermería.