Interruption Of Exclusive Breastfeeding Research Articles

Infant and Maternal Morbidity Symptoms as Predictors for the Interruption of Exclusive Breastfeeding in Lima, Peru: A Prospective Study

The global prevalence of exclusive breastfeeding for 6 months is 48%. This analysis examined the relationship between infant and maternal morbidity symptoms and the interruption of exclusive breastfeeding. Data from a cohort study among women living in a peri-urban community in Peru were used. Data were collected during pregnancy, birth, and the first 6 months postpartum among 179 dyads... After the first month, interruption of exclusive breastfeeding was almost twofold (adjusted odds ration [aOR] = 1.99, 95% confidence interval [CI]: 1.14, 3.45) more likely among infants with symptoms (e.g., diarrhea, cough) than those without. Maternal morbidity symptoms (e.g., gastrointestinal, respiratory) and breast problems were positively associated with interruption of exclusive breastfeeding throughout the first 6 months (aOR = 1.77, 95% CI: 1.11, 2.82 and aOR = 3.23, 95% CI: 1.84, 5.69, respectively). Mother-infant dyads often experience illness symptoms that are not contraindications to breastfeeding. Health professionals need to reinforce that exclusive breastfeeding should continue during illness.

Exclusive Breastfeeding Interruption in a Comprehensive Support Setting in Western Kenya: Secondary Analysis of PROSYNK Study Data

Exclusive Breastfeeding Interruption in a Comprehensive Support Setting in Western Kenya: Secondary Analysis of PROSYNK Study Data

Prevalência e fatores associados a interrupção do aleitamento materno em menores de dois anos: Pesquisa Estadual de Saúde e Nutrição

Abstract Objectives: to determine the prevalence of breastfeeding interruption and associated factors in children under two years old living in Pernambuco. Methods: cross-sectional study using data from the IV Pesquisa Estadual de Saúde e Nutrição (IV State Health and Nutrition Survey), a household-based survey, carried out in 2015/2016. The information was obtained through standardized forms applied to the children’s mothers and/or guardians. In a subsample of 358 children under two years old. Results: the prevalence of exclusive breastfeeding (EBF) interruption was 76.2% and of breastfeeding 61.7%. In the multivariate regression analysis, the following remained associated with EBF interruption: age range from three to six months (RP= 1.10; CI95%=1.01-1.21) and current or previous use of a pacifier (RP = 1.18; CI95%= 1.07-1.30). For breastfeeding between six and 24 months: economic class D or E (RP=1.08; CI95%=1.01-1.16); maternal work (PR=1.10; CI95%=1.02-1.18); black/mixed color mother (PR=1.07; CI95%=1.00-1.14); not having had a puerperal consultation (PR=1.08; CI95%=1.00-1.16); age group from 19 to 24 months (RP=1.09; CI95%=1.01-1.17) and among those who currently or previously used a pacifier (RP=1.40; CI95%=1.31-1.50). Conclusions: the high prevalence of early weaning reveals the need to implement policies to support and encourage breastfeeding, considering the main associated factors.

Women's Satisfaction with Breastfeeding and Risk of Exclusive Breastfeeding Interruption.

This prospective cohort study was conducted to evaluate the association between women's satisfaction with breastfeeding at 1 month post-partum and the risk of exclusive breastfeeding (EBF) interruption before 6 months. 287 mother-infant dyads randomly selected from two maternity hospitals were followed from birth to 24 months of infant's age. Women's satisfaction with breastfeeding was assessed using the Maternal Breastfeeding Evaluation Scale (MBFES) at 1 month. The association between women's satisfaction with breastfeeding and risk of EBF interruption before 6 months was estimated using Cox proportional hazards model. Kaplan-Meier survival curves for EBF were compared between women with lower satisfaction with breastfeeding (MBFES score < median 124) and those with higher satisfaction (MBFES score ≥ 124). Median EBF duration in women with higher satisfaction was 120 days (95%CI 109-131), vs. 26 days (95%CI 19-33) in less satisfied women. Each additional point on MBFES promoted a reduction of 2.0% in the risk of EBF interruption. Among women with satisfaction scores < 124, the risk of EBF interruption was 86% higher when compared with those ≥ 124 (adjusted hazard ratio 1.86; 95%CI 1.41-2.46). Lower maternal satisfaction with breastfeeding in the first month post-partum is associated with a higher risk of EBF interruption before 6 months.

The practice of exclusive breastfeeding and factors associated with its interruption

Objective: To investigate the prevalence of exclusive breastfeeding (EA) and factors associated with its interruption among mothers of children from 0 to 6 months of age in the municipality of Santo Antônio de Jesus -BA. Method: Cross-sectional study with 278 mothers, attended in health units of the municipality. Data were collected through interviews. Through hierarchical multiple analysis, a crude and adjusted prevalence ratio (PR), and their respective confidence intervals (95% CI) were calculated. Results: The prevalence of exclusive breastfeeding was 39.6%. The variables race/skin color (nonblack), primiparity, absence of family support for breastfeeding, dissatisfaction during breastfeeding, and pacifier use were associated with interruption of the outcome. Conclusion: The frequency of exclusive breastfeeding was below the indicator recommended by the Ministry of Health. Among the factors that were associated with the interruption of exclusive breastfeeding are socioeconomic characteristics related to reproductive history and lifestyle, as well as conditions related to the child. More effective breastfeeding promotion measures are necessary to mitigate this outcome.

Newborn Weight Loss as a Predictor of Persistence of Exclusive Breastfeeding up to 6 Months.

ObjectivesTo investigate the association between neonatal weight loss and persistence of exclusive breastfeeding up to 6 months.Study DesignAn observational cohort study in the setting of a Baby Friendly Hospital, enrolling 1,260 healthy term dyads. Neonatal percentage of weight loss was collected between 48 and 72 h from birth. Using a questionnaire, all mothers were asked on the phone what the infant's mode of feeding at 10 days, 42 days and 6 months (≥183 days) from birth were. The persistence of exclusive breastfeeding up to 6 months and the occurrence of each event that led to the interruption of exclusive breastfeeding were verified through a logistic analysis that included 40 confounders.ResultsInfants with a weight loss ≥7% were exclusively breastfed at 6 months in a significantly lower percentage of cases than infants with a weight loss <7% (95% CI 0.563 to 0.734, p < 0.001). Weight loss ≥7% significantly increases the occurrence of either sporadic integration with formula milk (95% CI 0.589 to 0.836, p < 0.001), complementary feeding (95% CI 0.460 to 0.713, p < 0.001), exclusive formula feeding (95% CI 0.587 to 0.967, p < 0.001) or weaning (95% CI 0.692 to 0.912, p = 0.02) through the first 6 months of life.ConclusionsWith the limitations of a single-center study, a weight loss ≥7% in the first 72 h after birth appears to be a predictor of an early interruption of exclusive breastfeeding before the recommended 6 months in healthy term exclusively breastfed newborns.

Determinants of the interruption of exclusive breastfeeding at the 30th day after birth.

ABSTRACTObjective:To estimate the prevalence of exclusive breastfeeding (EBF), introduction of water, herbal teas, or other milks, as well as to identify the factors associated with the interruption of EBF at the 30th day after birth.Methods:This is a cross-sectional study using structured and pretested questionnaires applied to 310 mothers in two moments: in person, at the maternity ward; and at the time the infant was 30 days of age, by telephone call. Descriptive statistics and multivariate Poisson regression, following a multilevel hierarchical model according to the proximity to the outcome, were used to estimate the association between dependent and independent variables.Results:The maintenance of EBF at 30 days of age of the infant occurred in 85.2% of the sample, 1.6% receiving water, 11.5% herbal teas, and 8.2% other milk. Predictors for EBF interruption in the univariate analysis were the mothers’ return to work or study activities shortly after the baby's birth (IR 2.88; 95%CI 1.14–7.25) and the use of a pacifier (IR 3.29; 95%CI 1.52–6.22). The interruption of EBF was lower in the group of participants who received support from the infant's maternal grandmother (IR 2.71; 95%CI 1.11–6.56) and their partner (IR 4.78; 95%CI 1.90–12.06). After a multivariate analysis, only the use of a pacifier (IR 5.47; 95%CI 2.38–19.3) and the partner's support (IR 6.87; 95%CI 2.04–23.1) maintained the association with the outcome.Conclusions:The prevalence of EBF found in this study can be considered good, and future interventions aimed at increasing the duration of EBF in this population should take into account the participation of the partner and the reinforcement for not introducing the pacifier.

Consequences of Using Artificial Nipples in Exclusive Breastfeeding: An Integrative Review

Objective: To describe the consequences of using artificial nipples to exclusive breastfeeding. Materials and method: An integrative review carried out in the Medline®, Cinahl, Lilacs, Web of Science, and Scopus databases to answer the following question: What are the consequences of using artificial nipples to exclusive breastfeeding? Results: 38 articles were analyzed; the analysis gave rise to two categories: neonatal factors and maternal factors influencing exclusive breastfeeding. Breastfeeding interruption was the neonatal factor most associated with the use of artificial nipples, while the level of maternal education stood out as an intervening factor in exclusive breastfeeding. Pacifiers were the dummy type more commonly mentioned, followed by feeding bottles and nipple shields. Conclusions: The consequences of offering artificial nipples to breastfed infants are mostly negative and associated with the newborn, such as early weaning, refusal to breastfeed, impaired suction technique, incorrect latch-on, interference with orofacial development, and interruption of exclusive breastfeeding. Mothers who offered artificial nipples to their infants are more likely to experience pain, nipple fissures, frustration, and reduced interaction with their infants.

Early exclusive breastfeeding cessation and postpartum depression: Assessing the mediating and moderating role of maternal stress and social support.

Early termination of exclusive breastfeeding (EBF) and postpartum depression (PPD) are both recognized as global health problems. Recent literature reviews demonstrate a notable link between PPD and breastfeeding outcomes, however, the underlying mechanisms linking the two remain unclear. The aim of the study is to: 1) explore the comparative risk for PPD among new mothers who terminated EBF before the 6-month mark, compared to those who did not; and 2) test whether maternal stress and social support operate to mediate and/or moderate the relationship between EBF and PPD. Between October 2015 and January 2016, a cross-sectional study was carried out among 426 new mothers of Bangladesh who were six months postpartum. Based on the multivariate logistic regression model, non-exclusively breastfeeding mothers were 7.58-fold more likely to experience PPD (95% CI [3.94, 14.59]) than exclusively breastfeeding mothers. Additionally, maternal stress and social support not only partially mediate the relationship between EBF and PPD but also substantially moderate this relationship. Specifically, the odds of PPD are significantly higher among mothers who had early EBF interruption in conjunction with increased stress levels and limited social support. Current evidence suggests that concurrent screening for EBF difficulties and maternal stress are important red flags that might hint at complications even before mother's screen positive for PPD. Support and care from family members can provide assistance in overcoming this issue.

Determinants of optimum exclusive breastfeeding duration in rural India: a mixed method approach using cohort and content analysis design

BackgroundDespite established benefits, exclusive breastfeeding (EBF) rate remains poor in India. This study measured the rate of early initiation of breastfeeding and EBF up to 42 days postpartum period and the reasons associated with early interruption of it.MethodsIn this study we followed a cohort 319 mother-newborn dyads, on a scheduled day of each week for six postpartum weeks (42 postpartum days), during May 2017 – March 2019. We used standard maternal 24 h recall method to collect data on newborn feeding practices. Additionally, using content the analysis method, we analysed the data captured through open ended question on current breastfeeding practice and reasons to identify the sociocultural facilitators/barriers of exclusive breastfeeding .ResultsOf the retained 306 newborns, early initiation of breastfeeding rate was 60% (184/306), whereas, EBF rate was 47% (143/306). Mothers’ educational level did not emerge as a risk for unsuccessful breastfeeding practices, whereas, father being not the major earner of the family (Relative risk [RR] 2.4; 95% Confidence interval [CI] 1.7,3.3), mothers who did not believe that effect of breastfeeding is longstanding (RR 1.8; 95% CI 1.3, 2.1) emerged as a risk for unsuccessful EBF practices. Lack of self-conviction about EBF among mothers; significant family members’ influence; cultural beliefs; emerged as major socio-environmental barriers of early interruption of exclusive breastfeeding. Repeated counselling by the healthcare provider particularly focusing on exclusive breastfeeding, supportive family environment in terms of the elders being aware of the positive health outcomes of it, and prior positive experience emerged as the socio-environmental facilitators for successful EBF until 42 postpartum days.ConclusionsWe conclude that the socio-environmental causes need to be addressed through the present healthcare delivery system for ensuring better infant feeding outcome.

Timing of sugar introduction in diet and early childhood caries: a population-based study in preschoolers

Abstract Introduction Sugar ingestion is the most important isolated factor related to dental caries. Contact with sugary foods at an early age may represent a risk to the oral health of preschool children. Objective To evaluate the timing of the introduction of sugar in the diet of preschoolers and its association with early childhood caries. Material and method Cross-sectional population-based study with 888 five-year-old preschoolers from public and private schools. Parents answered a questionnaire on sociodemographic data, eating habits and oral health. The variables timing of sugar introduction (&gt;1 year and ≤1 year) and dental caries experience were dichotomized and data were analyzed using descriptive statistics and Poisson regression (p&lt;0.05). Result The introduction of sugar in the diet occurred during the first twelve months of life for 73.8% of preschoolers. There was no association between the timing of sugar introduction and early childhood caries (p&gt;0.05). The interruption of exclusive breastfeeding and low family income increased the prevalence of preschoolers having early contact with sugar by 32% and 23%, respectively (p&lt;0.05). The prevalence of early childhood caries was 42.3% and was associated with a lower level of maternal education, low income, increased frequency of ingestion of candy and the use of nonfluoridated toothpaste (p&lt;0.05). Conclusion The introduction of sugar in the diet occurred during the first year of life in most preschoolers and there was no association with early childhood caries.

Determinants of early breastfeeding initiation and exclusive breastfeeding in Colombia.

To identify modifiable risk factors associated with early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) in Colombia. Cross-sectional study from the 2010 Colombia nationally representative Demographic Health Survey (DHS). Studied exposures were categorized into five hierarchical blocks of increasing proximity to the outcomes: household, maternal, health systems, child, and early feeding characteristics. The two outcomes examined were delayed breastfeeding initiation among infants <24 months and interruption of EBF among infants <6 months. Prevalence ratios were computed using Poisson regression analysis with robust error variance, adjusted for sampling weights, following a hierarchical modelling approach. Nationally representative cross-sectional survey from Colombia. The EIBF analytical sample included 6592 and the EBF sample 1512 women with young children. EIBF prevalence was 65·6 % in children under 24 months and EBF was 43 % in infants under 6 months. Modifiable risk factors associated with delayed breastfeeding initiation were: C-section (PR = 2·08, CI 95 % = 1·92, 2·25), maternal overweight/obesity (PR = 1·09, CI 95 % = 1·01, 1·17), lack of skilled attendant at birth (PR = 1·09, CI 95 % = 1·01, 1·18). Modifiable risk factors for EBF interruption were C-section (PR = 1·12, CI 95 % = 1·02, 1·23) and prelacteal feeding (PR = 1·51, CI 95 % = 1·37, 1·68). Non-pregnancy intention was a protective factor for EBF interruption (PR = 0·82, CI 95 % = 0·72, 0·93). C-section, lack of skilled attendant at birth, prelacteal feeding, maternal nutritional status, and pregnancy intention were modifiable factors associated with suboptimal breastfeeding practices in Colombia.

Prevalence and Maternal Concerns of Exclusive Breast Feeding in Libyan Women in Albaida City

Exclusive breastfeeding (EBF) is strongly recommended by the World Health Organization, United Nation Children's Fund (UNICEF), and American Academy of Pediatrics during the first six months of life. Breastfeeding should continue up to two years for optimal growth and development while it is suggested to start supplementary foods beginning from the seventh month. The study aimed to determine the frequency and examine the affecting factors of EBF in infants who attended the pediatrics outpatient clinic in Althawra Hospital in Albaida city, Libya. A cross-sectional study was conducted in eight months period among 223 breastfeeding mothers, with infants aged 6-24 months, who attended the pediatrics Outpatient clinic. Mothers’ perceptions about breastfeeding, complementary feeding practices, and demographic characteristics were collected by interviews with them. EBF periods were 1-45 weeks, Median week was 17 weeks. Six months EBF rate was 32,28%. Younger mother (≤ 20) or older (≥35) ages, and mothers having chronic diseases had a shorter median week of EBF. The median duration of breastfeeding was 9 months (0-24 months). The most frequent reason of the early interruption of EBF was, according to mother’s perceptions, for having inadequate breast milk (50.3 %). The study indicates that the frequency of 6 months EBF (32,28%) and the median duration of breastfeeding (17 weeks) are low in Albaida. A local strategy must be developed to overcome mothers negative perceptions about EBF in the first 6 months of age.

Influence of Maternity Leave on Exclusive Breastfeeding: Analysis from Two Surveys Conducted in the Federal District of Brazil.

Since the 1980s, Brazil has implemented several initiatives to support breastfeeding. Maternity leave, paid in full for 16 weeks, has been available since 1988. However, few studies in Brazil have analyzed the impacts of maternity leave on breastfeeding using population-based indicators. The aim was to analyze the association between maternity leave and exclusive breastfeeding interruption in children younger than 4 months residing in the Federal District of Brazil, in 2008 and 2014. Data from two surveys were used: the 2008 Second National Survey on Prevalence of Breastfeeding and the 2014 Monitoring of Infant Feeding Practices. The sample included 1,742 mothers with children younger than 4 months residing in the Federal District and using the Public Unified Health System. The main independent variable was the mother being on maternity leave and the outcome was interruption of exclusive breastfeeding. Multiple analyses were performed to test the association between maternity leave and the risk of interrupting exclusive breastfeeding, adjusting for socioeconomic, demographic, and biomedical characteristics. In 2008 and 2014, the prevalence of exclusive breastfeeding was 60% and 71.4% and prevalence of maternity leave was 27% and 41%, respectively. The lack of maternity leave was strongly associated with interruption of exclusive breastfeeding in 2008 (prevalence ratio [PR] = 1.78, 95% confidence interval [CI] [1.12, 2.82]) and in 2014 (PR = 3.95, 95% CI [1.88, 8.31]) after adjusting for confounding variables. Not being on maternity leave was strongly associated with the interruption of exclusive breastfeeding among employed women residing in the Federal District.

FACTORES MATERNOS QUE INTERVIENEN EN LA INTERRUPCIÓN DE LA LACTANCIA MATERNA EXCLUSIVA EN UN HOSPITAL PÚBLICO

Introducción: El objetivo del presente estudio fue identificar los factores maternos que intervienen en la interrupción de la lactancia materna exclusiva en el Hospital Hermilio Valdizán de Huánuco. Métodos: Se realizó un estudio prospectivo de casos y controles mediante la aplicación de una encuesta a 196 mujeres que atendieron su parto en un Hospital Público de la ciudad de Huánuco, que cuyos niños cumplieron los 6 meses de edad en el año 2010, las variables estudiadas como factores de interrupción de la lactancia materna exclusiva fueron: tipo de parto, paridad, ocupación, percepción de la cantidad de leche producida, mastitis puerperal y uso temprano de fórmula láctea en el hospital. Resultados:Se analizaron 98 casos y 98 controles, de los cuales se halló relación con la interrupción de la lactancia materna exclusiva: parto por cesárea (67.2%), madres que trabajan fuera del hogar (100%), madres que percibían como insuficiente la producción de leche (100%), uso temprano de fórmula láctea (100%); madres con más de dos hijos (54.8%), en cuanto a paridad y a grupo etario de supuesto mayor riesgo (&lt;18 y &gt;35 años) no se halló diferencia significativa; el análisis multivariado demostró que la mastitis puerperal y el uso temprano de fórmula láctea en el hospital explican en un 98.68% la interrupción de la lactancia materna exclusiva en dicha población, todos ellos con IC=95%; p&lt;0.05. Conclusiones: Fueron factores asociados a la interrupción de la lactancia materna exclusiva la mastitis puerperal y el uso temprano de fórmula láctea en el hospital.

Influence of maternity leave on exclusive breastfeeding

ObjectivesTo describe the profile of women with children aged under 4 months living in the Brazilian state capitals and in the Federal District according to their working status and to analyze the influence of maternity leave on exclusive breastfeeding (EBF) among working women. MethodsThis was a cross‐sectional study with data extracted from the II National Maternal Breastfeeding Prevalence Survey carried out in 2008. Initially, a descriptive analysis of the profile of 12,794 women was performed, according to their working status and maternity leave and the frequency of maternity leave in the Brazilian regions and capitals. The study used a multiple model to identify the influence of maternity leave on EBF interruption, including 3766 women who declared they were working and were on maternity leave at the time of the interview. The outcome assessed in the study was the interruption of the EBF, classified by the WHO. ResultsRegarding the working status of the mothers, 63.4% did not work outside of their homes and among those who worked, 69.8% were on maternity leave. The largest prevalence among workers was of women older than 35 years of age, with more than 12 years of schooling, primiparous and from the Southeast and South regions. The lack of maternity leave increased by 23% the chance of EBF interruption. ConclusionMaternity leave contributed to increase the prevalence of EBF in the Brazilian states capitals, supporting the importance of increasing the maternity leave period from four to six months.

Influence of maternity leave on exclusive breastfeeding

ObjectivesTo describe the profile of women with children aged under 4 months living in the Brazilian state capitals and in the Federal District according to their working status and to analyze the influence of maternity leave on exclusive breastfeeding (EBF) among working women. MethodsThis was a cross-sectional study with data extracted from the II National Maternal Breastfeeding Prevalence Survey carried out in 2008. Initially, a descriptive analysis of the profile of 12,794 women was performed, according to their working status and maternity leave and the frequency of maternity leave in the Brazilian regions and capitals. The study used a multiple model to identify the influence of maternity leave on EBF interruption, including 3766 women who declared they were working and were on maternity leave at the time of the interview. The outcome assessed in the study was the interruption of the EBF, classified by the WHO. ResultsRegarding the working status of the mothers, 63.4% did not work outside of their homes and among those who worked, 69.8% were on maternity leave. The largest prevalence among workers was of women older than 35 years of age, with more than 12 years of schooling, primiparous and from the Southeast and South regions. The lack of maternity leave increased by 23% the chance of EBF interruption. ConclusionMaternity leave contributed to increase the prevalence of EBF in the Brazilian states capitals, supporting the importance of increasing the maternity leave period from four to six months.

Prevalence and associated factors for early interruption of exclusive breastfeeding: meta-analysis on Brazilian epidemiological studies

Abstract Objectives: to summarize Brazilian studies that analyzed the risk factors for Exclusive Breastfeeding (EBF) interruption before the child's six months of life. Methods: systematic review and meta-analysis indexed articles from Bireme, Scielo and Pubmed databases published in the period of January 2000 to December 2015. Results: 22 articles were included in the meta-analysis. The factors related to newborns were observed, such as birth weight (OR= 1.17; CI 95%: 1.05-1.29), female gender (OR= 1,09; CI 95%: 1.04-1.13) and the use of pacifier (OR= 2.29; CI 95%: 1.68-2.91) were the main factors responsible for the increase in the occurrence of EBF interruption. The factors were related to the mother, maternal age below twenty years old (OR= 1.22; CI 95%: 1.12-1.33) low schooling level (OR=1.28; CI 95%: 1.11-1.45), primiparity (OR= 1.17; CI 95%: 1.02-1.32) maternal employment during the postpartum period (OR= 1.26; CI 95%: 1.11-1.41), and low family income (OR= 1.22; CI 95%: 1.08-1.37) contributed significantly to the EBF interruption . Conclusions: the meta-analysis of Brazilian epidemiological studies demonstrated evidences to conclude that below the age of twenty, low schooling, primiparity, maternal employment in the postpartum period and low family income are associated to the interruption of exclusive breastfeeding until 6 months of age. Children with low birth weight, female gender and used a pacifier had greater vulnerability to not be exclusively breastfed. In conclusion, most of these factors can be modified through appropriate public policies throughout the adequate prenatal period to promote exclusive breastfeeding.

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.

HUMAN MILK BANK: THE BREASTFEEDING COUNSELING AND THE DURATION OF EXCLUSIVE BREASTFEEDING

Objective: T o identify which sociodemographic factors are associated with early weaning and compare the duration of exclusive breast feeding between mothers which received counseling about maternal feeding and mothers which was not guided for these practices. Methods: A cross-sectional study with 25 mothers that received counseling about the benefits of maternal feeding in the human milk bank and 25 from a university hospital that were not counseled. Data were collected using a structured questionnaire addressing mother-related data, the infant and the breastfeeding in the first semester. Comparison and odds ratio were the statistical analyses adopted. Results : There was not a significant difference of the duration of exclusive breast-feeding between the two groups (p = 0,524). Among mothers in the human milk bank group that discontinued early exclusive breast-feeding, fewer children (p=0,034) and a higher frequency of maternal work (p = 0,022) were observed. Wile, in the university hospital group low education (p < 0.001) and lower income (p = 0.009) were prevalent. In the totality of the sample, the interruption of exclusive breast-feeding was associated with <1 children (OR = 0.21, p = 0.030), the presence of a partner (OR = 0.046, p = 0.001) and the use of bottles or pacifiers (OR = 87.5, p <0.001). In both groups, the most cited motivation for exclusive breast-feeding discontinuation was the medical assistance. It was observed the absence of a specific standard guideline provided in the Human Milk Bank, and less than the recommended number of consultations in the literature. Conclusions: Socioeconomic factors and inadequate incentives negatively influence the duration of exclusive breast feeding. It was verified the need to provide standardized and more frequent counseling for effective reduction of early weaning.