Length Of Breastfeeding Research Articles

P0214 PHENOTYPIC EXPRESSION OF LIVER DISEASE IN FAMILIES WITH PIZZ ALPHA-1-ANTITRYPSIN DEFICIENCY

Introduction: PiZZ alpha-one-antitrypsin deficiency (A1ATD) is the commonest genetic cause of chronic liver disease leading to liver transplantation in children. The pathogenic mechanism appears to involve abnormal loop sheet polymerisation of the aberrant PiZ alpha-1-antitrypsin and its retention in the hepatocyte endoplasmic reticulum, with consequent progression to chronic inflammation and cirrhosis. Only 10–15% of PiZZ individuals develop clinical symptoms and additional genetic and environmental modifiers have been postulated. Methods: The database of 279 children diagnosed with A1ATD at our centre between 1978–2002 was reviewed to identify families in which there was more than one child with the PiZZ phenotype. A retrospective analysis of their notes was carried out to assess the severity of their liver disease. Results: Forty-two children (24 boys) from twenty-one families were identified, including 2 pairs of monozygotic and 1 pair of dizygotic twins. The children were followed up for a median of 66 months (range, 8–185 months). The patients were divided into the following categories: (A) asymptomatic/family screening –4.8%; (B) no clinical liver disease after neonatal biochemical dysfunction – 30.9%; (C) mild ongoing liver dysfunction – 35.7%; (D) moderate chronic liver disease – 19.1% and (E) end stage liver disease/liver transplant – 9.5%. There were no significant differences in the length of breastfeeding or frequency of infection between the siblings. Only 5/21 sibling pairs (23.8%) were within the same category. Of note, of those children requiring liver transplant 3/4 had siblings within categories A or B. Of the three pairs of twins identified, the twins were in different categories in 2 out of 3. Six out of 12 children in the D and E categories were male. Amongst the families where a child had end stage liver disease (E), 6 sought an antenatal diagnosis. Two of the foetuses were PiZZ and the pregnancies were terminated, the remainder were heterozygotes. Two of the families with moderate chronic liver disease (D) were also tested antenatally: one was a heterozygote and the other a PiZZ foetus was lost as a consequence of a mid-trimester spontaneous abortion. Conclusion: In the relatively small sample of families reviewed, the clinical course of liver disease within siblings with PiZZ A1ATD was highly variable. This observation, if confirmed in a larger sample, is important because antenatal diagnosis of PiZZ A1ATD may not predict the extent of liver involvement in families where one child has been affected by end stage liver disease, as has been previously reported.

P1109* EFFECT OF IRON SUPPLEMENTATION IN PREGNANCY ON IQ OF CHILDREN AT 4 YEARS OF AGE

Introduction: Evidence from animal studies has consistently demonstrated that inadequate iron nutrition during pregnancy leads to permanent structural and functional changes in the brain of offspring. However, there are no human trials specifically designed to examine the effect of iron supplementation in pregnancy on childhood neurodevelopment. Our aim was to assess the IQ of children at 4 years of age whose mothers had previously participated in a double blinded randomised controlled trial (RCT) of iron supplementation in pregnancy [1]. Methods: Families who participated in the RCT [1] during 1997–1999 were invited to participate in a follow up study when the children were 4 years of age. The IQ of the children was assessed using the Stanford– Binet Intelligent Test (4th Ed). Weight, height and head circumference were measured and iron status was assessed. Additional information on possible confounders of child development such as home environment and length of breastfeeding are also collected. Results: Seventy-seven percent (303/391) of the children from the original trial consented to participate in the follow up study, 8% (31/391) were lost to follow up and 15% (57/391) refused to participate. Data collection is complete for 290/303 children and 13 children remain to be assessed to complete the study. Results collected to date show that the mean age of children at assessment is 4.17 ± 0.23 years. The mean total IQ for children assessed thus far (n=290) is 109 ± 11, while verbal IQ is 109 ± 12, visual IQ is 104 ± 10, quantitative reasoning IQ is 114 ± 12 and short-term memory IQ is 104 ± 12. Mean haemoglobin at assessment is 123 ± 7 g/L (n=210) and mean serum ferritin is 21 ± 12 ug/l (n=209). Data collection is ongoing and will be completed by the end of December 2003. Primary comparisons will be made between the IQ of children from iron supplemented mothers and the IQ of children from placebo supplemented mothers. Adjustment will be made for possible confounding variables. We are unable to perform the statistical analysis for the primary comparisons at this stage as we can not unblinded the trial until all data collection is complete. Conclusion: If iron supplementation in pregnancy results in higher IQ of children, we believe that this will necessitate a reevaluation of the critical period of iron nutrition for influencing neurodevelopment.

Aboriginal mothers, breastfeeding and smoking

Objective: To document the smoking practices of Aboriginal mothers living in Perth during pregnancy and during the subsequent year while feeding their infants.Method: A cohort of mothers was followed from the time of delivery for 12 months to obtain details of infant feeding practices. A total of 455 mothers delivered between May 2000 and July 2001 and 425 completed the baseline questionnaire.Results: Prior to and during pregnancy, 67% of the mothers smoked regularly. While the rate appeared to decline slightly with the length of breastfeeding, the trend was not significant. The rate of smoking of Aboriginal mothers was significantly greater than for an earlier study of non‐Aboriginal mothers in Perth, where the rate was 28.4%. Among Aboriginal women there was no difference in the percentage of smokers and non‐smokers who initiated breastfeeding. While fewer women who smoked were still breastfeeding at 24 weeks postpartum, compared with non‐smokers (58% vs. 64%), this difference was not significant.Conclusions: The percentage of women smoking in this study is consistent with rates reported in the 2001 National Drug Strategy Household Survey. In other studies, smoking is associated with lower rates of breastfeeding initiation and duration, but this was not the case in the Aboriginal mothers.Implications: Although the high prevalence of smoking identified in this study did not appear to adversely affect breastfeeding, smoking during and after pregnancy does contribute to increased rates of low birth weight and other health problems in early childhood. Targeted antenatal smoking cessation programs are needed for Aboriginal mothers.

Prenatal exposure to organochlorine compounds and allergic eczema in one year old children

Rationale Several hypotheses have been suggested to explain the increase in allergic diseases. The effect of xenobiotics such as organochlorine compounds have not been clearly established, though some studies have shown their immune modulatory potential. Methods In a randomly selected group of 180 mothers giving birth to healthy newborns after a physiologic pregnancy, the samples of placental tissue were collected and evaluated for the concentrations of 18 selected organochlorine compounds (PCBs, organochlorine insecticides, and chlorinated benzenes). Children of these selected mothers were physically evaluated at 12 months of age, sample of blood was taken for analyses of specific IgEs against relevant allergens (Pharmacia CAP System™) and a questionnaire was introduced for symptoms of eczema and doctors diagnosis of eczema. Results Out of 161 children examined at 12-month 17 (10,6%) had doctor-diagnosed allergic eczema. The median of the total sum of organochlorine compounds in the placental tissue was significantly higher in the group of children with eczema (0,011 versus 0,006; p=0,009). When testing individual compounds we found significant association for DCB1413, DCB12 and PCB52 and eczema in children (p<0,05, respectively). Adjustment for potential confounders like maternal allergy, length of breast feeding, passive smoking, farming and pet exposure did not abrogate this effect. There were no association between placental concentrations of organochlorine compounds and specific IgE blood levels. Conclusions Our results show an association between placental contamination with organochlorine compounds as a proxy measure of prenatal exposure to these substances and clinical manifestation of allergic eczema in 12 months old children.

Breastfeeding patterns of primiparous mothers in Hong Kong.

An understanding of patterns of breastfeeding is necessary for the effective implementation of breastfeeding promotion and intervention programs. In Hong Kong, little current data have been gathered on women's breastfeeding rates. The objective of this study was to determine how patterns of breastfeeding, maternal demographics, and maternal employment affect continuation of breastfeeding in primiparous women in Hong Kong. A longitudinal self-report survey was used to collect data when first-time mothers (n=218) were in the hospital, at 1, 3, 6, 9, and 12 months postpartum, or until they weaned their infant. All data (self-report survey, demographic data, and follow-up telephone surveys) were collected in Cantonese and then translated into English. Data were analyzed by determining, first, the influence of individual variables on the length of breastfeeding using a simple Cox regression analysis, and second, by grouping variables according to time sequence and entering them into a Cox regression model in 4 sequential phases. Factors that were significantly associated with continuation of breastfeeding were maternal age (HR=0.97; p=0.048); attendance at a prenatal breastfeeding class (HR=0.69; p=0.020); intended weeks of breastfeeding (HR=0.97; p<0.001); breastfeeding score in hospital (HR=0.99; p=0.009); and length of exclusive breastfeeding (HR=0.93; p<0.001). Similar results were obtained in the multiphase Cox regression analysis; only the breastfeeding score in hospital became marginally insignificant (p=0.053) after adjusting for demographics, prenatal, and other immediate postpartum factors. Short periods of exclusive breastfeeding and early supplementation were common in this sample. Unlike previous research, maternal employment was not a statistically significant factor in length of continued breastfeeding. Study findings show that multiple factors influence continued breastfeeding in Hong Kong, suggesting further areas for investigation. Changes in practice may improve continued and exclusive breastfeeding rates.

Anticuerpos anti-albúmina bovina (BSA) en niños diabéticos tipo 1 recién diagnosticados y su asociación con lactancia materna y exposición a leche de vaca

Environmental and genetic factors (viruses, toxins and diet) are involved in the aetiology of type 1 diabetes. Among the dietary factors, the role of breast feeding and exposure to cow's milk proteins deserve special attention. To determine the anti-BSA-IgG levels in type 1 diabetic children and to analyse the possible association with breast feeding duration, exposure to cow's milk and beta pancreatic auto-antibodies. Blood samples were collected from 161 diabetic children and 144 controls to measure anti-BSA-IgG level, GAD65, IA-2 and ICA autoantibodies. All children answered a questionnaire about dietary habits during infancy. anti-BSA-IgG was positive (using a cut off point of 25.6 ng/ml) in 98% of diabetic children and 0% of the control population. The length of breast feeding or early exposure to cow's milk did not influence the concentration of anti-BSA-IgG. Positive BSA titers did not increase the beta pancreatic reactivity (ICA+, GAD+, IA2+). Our data confirm the high frequency of anti-BSA-IgG among diabetic children. However, a specific role in the immunological process of type 1 diabetes cannot be attributed to this protein.

Termination of breastfeeding after 12 months of age due to a new pregnancy and other causes is associated with increased mortality in Guinea-Bissau.

As part of an assessment of breastfeeding and child health in Guinea-Bissau, we investigated the impact of mother's reason for weaning on subsequent child mortality. Children were identified and followed by the demographic health surveillance system of the Bandim Health Project in Guinea-Bissau. Breastfeeding status and survival were ascertained by 3-monthly follow-up home visits. At termination of breastfeeding mothers were interviewed about her reasons for weaning. In all, 1423 children who terminated breastfeeding after 12 months of age were followed to 3 years of age. Median length of breastfeeding was 22 months. Following termination of breastfeeding, 66 children died before 36 months of age. In all, 62% (879/1423) were weaned because they were 'healthy'. Compared with the 'healthy' children, all other causes of weaning were associated with a higher mortality (mortality ratio [MR] = 2.97, 95% CI: 1.54-5.73). For 237 children weaned due to a new pregnancy the MR was 3.25 (95% CI: 1.45-7.30). Seventy-five children weaned because of illness had a 2.98 (95% CI: 0.95-9.39) fold excess mortality compared with children considered healthy. Excess deaths in the 'non-healthy' group accounted for 44% (29/66) of post-weaning deaths. Median length of spacing between an index child and a new sibling was 28 months irrespective of whether the index child survived or died before 3 years of age. The majority of the deaths occurred before birth of the new sibling. Popular rationalizations of abstinence during breastfeeding emphasizes, as we observed, that weaning due to new pregnancy of the mother is associated with higher mortality. This was not due to a shorter breastfeeding period of the child weaned due to a new pregnancy. Generally children weaned for other reasons than 'being healthy' had higher mortality. The mother's reason for weaning could potentially be used as screening criteria in child monitoring programmes in areas with high mortality.

Impact of smoking on the duration of breastfeeding in mothers with insulin-dependent diabetes mellitus

The effect of smoking on breastfeeding was studied in 252 mothers with insulin-dependent diabetes mellitus (IDDM) giving birth in the period 1985–1995 and of whom 31% were classified as White group B, 16% group C, 37% group D and 16% group F or R. As part of a centralized regimen a detailed smoking history was taken during pregnancy Forty-six percent were smokers. In 1997, a questionnaire was sent out asking for information on the duration of breastfeeding. The response rate was 87%. The duration of breastfeeding was significantly longer in the non-smoking group (p= 0.004). Fifty-five percent of non-smokers versus 33% of smokers were still breastfeeding 4 mo after birth. A strong dose-response relationship was established (p= 0.009). Cox multiple regression analysis showed a significantly negative influence of smoking (p= 0.01) and of hospitalization of the infants during the first year of life (p= 0.02) and a significantly positive influence of maternal age (p= 0.02) and birthweight (p= 0.03) on the length of breastfeeding. The breastfeeding curves for non-smokers and smokers were mainly divergent in the first month after birth, suggesting that the effect of smoking on breastfeeding is mainly exerted during that period. Conclusion: Smoking exerted a strong, negative, dose-dependent influence on breastfeeding duration in mothers with IDDM. Given the hazards of smoking, the advantages of breastfeeding and the possible link between being breastfed and later development of diabetes mellitus, these results should be taken into consideration when counselling pregnant women with IDDM about smoking.

Impact of smoking on the duration of breastfeeding in mothers with insulin‐dependent diabetes mellitus

The effect of smoking on breastfeeding was studied in 252 mothers with insulin-dependent diabetes mellitus (IDDM) giving birth in the period 1985-1995 and of whom 31% were classified as White group B, 16% group C, 37% group D and 16% group F or R. As part of a centralized regimen a detailed smoking history was taken during pregnancy. Forty-six percent were smokers. In 1997, a questionnaire was sent out asking for information on the duration of breastfeeding. The response rate was 87%. The duration of breastfeeding was significantly longer in the non-smoking group (p = 0.004). Fifty-five percent of non-smokers versus 33% of smokers were still breastfeeding 4 mo after birth. A strong dose-response relationship was established (p = 0.009). Cox multiple regression analysis showed a significantly negative influence of smoking (p = 0.01) and of hospitalization of the infants during the first year of life (p = 0.02) and a significantly positive influence of maternal age (p = 0.02) and birthweight (p = 0.03) on the length of breastfeeding. The breastfeeding curves for non-smokers and smokers were mainly divergent in the first month after birth, suggesting that the effect of smoking on breastfeeding is mainly exerted during that period. Smoking exerted a strong, negative, dose-dependent influence on breastfeeding duration in mothers with IDDM. Given the hazards of smoking, the advantages of breastfeeding and the possible link between being breastfed and later development of diabetes mellitus, these results should be taken into consideration when counselling pregnant women with IDDM about smoking.

Correlation between level of self‐regulation in the newborn infant and developmental status at two years of age

The purpose of this study was to investigate whether the level of self-regulation in the newborn baby (a) predicts later cognitive and social development, (b) correlates to duration of breastfeeding and (c) has an impact on sleeping rhythm and the infant's autonomic behaviour. The study involved 38 full-term infants of optimal health who were assessed at an age of 3 d using a screening instrument measuring neonatal self-regulation, low, ordinary and high. The instrument, a conditional global scale, developed on the basis of the items in the Neonatal Behavioral Assessment Scale, identifies three levels of self-regulation. Thirty-six of the infants participated in a follow-up study at 2 y of age, when they were tested with Griffiths' Mental Developmental Scales and one of the parents was interviewed about length of breastfeeding, sleeping habits and the infant's autonomic behaviour. The results showed that the level of self-regulation was correlated to 3 out of 5 variables (Personal-Social development, Hearing & Speech and Eye & Hand Coordination) in the Griffiths test. The results also indicated differences in sleeping rhythm as well as in breastfeeding patterns between the three groups. Furthermore, the study indicated gender-based differences in the level of neonatal self-regulation and confirmed previous findings of gender-based differences in achieved developmental level at 2 y of age assessed with Griffths' Mental Developmental Scales. The findings in this study indicate that infants with a low level of self-regulation are at risk for poorer social and cognitive development as well as regulatory disorders.

Mode of infant feeding and achieved growth in adolescence: early feeding patterns in relation to growth and body composition in adolescence.

Feeding mode in infancy and differences in childhood growth have been studied in several longitudinal studies, but few studies have followed children up to adolescent age. There is evidence that formula-fed infants weigh more and are taller than their breast-fed counterparts, and indications that this difference may sustain. We have studied the relations between length of breast-feeding, growth, and body composition in a group of 781 representatively chosen adolescents. Data on feeding pattern in infancy and on weight and height from birth up to 18 years were collected. We studied the relation between high body mass index (BMI) (defined as < or =85th percentile) in adolescence and length of breast-feeding. Girls who were not breast-fed or breast-fed for less than 3 months had a significantly higher height curve than girls exclusively breast-fed for more then 3 months. There were tendencies towards higher values of adipose tissue measured by skinfolds in girls breast-fed for 3 months or less. Short duration of exclusive breast-feeding was associated with higher BMI (p<0.04). In a subgroup of 194 adolescents, body composition was measured with dual energy X-ray. Both boys and girls who were exclusively breast-fed for more than 3 months were leaner and showed a trend towards lower skinfold values. These results are important to include in the debate about optimal feeding in infancy. Regarding breast-feeding as a standard, our results imply that formula fed infants may be at risk for overfeeding, which might lead to overweight, even up to adolescent age.

A Study of Prevalence of Protein Energy Malnutrition among 0–5 Years in Rural Benue State, Nigeria

Three hundred and seventy pre-school children (181 males and 189 females) were studied in order to document the prevalence of protein energy malnutrition and factors that militate it. The prevalence of protein energy malnutrition among the children was revealed to be 41.6% (154). One hundred and fiftyone (40.8%) of them were found to have weight-for-height below -2SD indicating level of stunting among the children. Most malnourished children belonged to mothers who were illiterate 97 (54.8%) when viewed from the mothers' educational perspective. This study also showed the following factors that were statistically significant with PEM: educational status of mothers (p<0.05), marital status (p<0.05) of mothers, occupational status of mothers (p=0.000), parental income per annum (p=0.000), length of breastfeeding (p=0.000), water supply and regularity, type of housing and toilet facilities. Intensification of health education aimed at encouraging beneficial childhood feeding practices in the community is needed together with further study on the subject, which will be directed at actual analysis of the nutritive values of available local foodstuffs as a prerequisite for an effective intervention programme.

Clinical symptoms and social factors in a cohort of children spontaneously clearing Helicobacter pylori infection

Tindberg Y, Blennow M, Granström M. Clinical symptoms and social factors in a cohort of children spontaneously clearing Helicobacter pylori infection. Acta Pædiatr 1999; 88: 631‐5. Stockholm. ISSN 0803‐5253In a cohort study of 305 Swedish children, repeated blood samples and structured questionnaires were obtained from 6 mo to 11 y of age. Of the 40 children seropositive for Helicobacter pylori in one or more samples, 32 (80%) had cleared the infection by 11 y of age. No association was found between H. pylori seropositivity at any time and reported antibiotic consumption, size of home and family, type of day‐care, history of atopic disease, length of breastfeeding or peptic ulcer disease in the family. Girls reported more (p = 0.002) unspecified abdominal pain during childhood than boys, but the difference in H. pylori infection rate (15/150, 10% for boys and 25/144, 17% for girls) was not significantly different (p = 0.09). Unspecified abdominal pain during childhood was reported more often (OR adjusted for gender = 2.2, 95% CI = 1.0‐4.4, p = 0.04) for the children seropositive at some point (17/39, 44%) than for the seronegative children (54/217, 25%). RAP at 11 y of age was more often reported by the 9/36 (25%) children seropositive at some time in life than by the 23/172 (13%) seronegatives, but the difference was not statistically significant (OR adjusted for gender = 2.0, 95% CI = 0.8‐4.6, p = 0.1). The study shows that H. pylori seropositivity was associated with a parental report of unspecified abdominal pain during childhood. Also, a history of unspecified abdominal pain was more common (OR = 51.6, 95% CI = 15.6‐220, p&lt; 0.001) in children reporting RAP at 11 y of age. □Childhood infection, H. pylori, socioeconomic conditions

Kangaroo Mother versus Traditional Care for Newborn Infants (2000 grams). A randomized Controlled Trial. † 1138

Objectives: This Open Randomized Controlled Trial compares effectiveness and safety of KMI and traditional care in LBW infants.Setting: The largest tertiary care hospital in Colombia, with neonatal intensive care and LBW infants follow-up clinic. Patients: Newborn infants (≤ 2000 g.) who survive the neonatal period and are eligible for an in-patient Minimal Care Unit (MCU). 1084 consecutive deliveries were followed and 746 were randomized (382 to KMI and 364 to control). Interventions: KMI infants were discharged as soon as they were randomized, regardless of weight or gestational age. Infants were kept 24 hr/day in an upright position, in skin-to-skin contact and firmly attached to the mother's chest until KMI wasn't tolerated anymore. Control infants were kept in incubators at the MCU until they satisfied usual discharge criteria. Both groups were followed at term and at 3, 6, 9 and 12 months of corrected age. Outcome measures: mortality, infectious episodes, length of hospital stay, growth and development, sequels and proportion of breast feed infants. Results: Baseline variables were evenly distributed, except weight at recruitment (KMI=1678, controls=1713, p=0.045). Risk of dying was lower in the KMI althought not significant (11/339-3.1%- vs. 19/324 -5.5%- RRO.57, 95%CI 0.27-1.17). There were no difference in growth or development indexes nor in length of breast feeding. KMI infants, specially those weighting under 1200 g. at birth spent less time in hospital although the difference was not significant. Number and severity of infections in survivors was similar. A larger proportion of Kangaroo infants was breast feed up to 3 months of corrected age, but the difference disappeared after that age. Conclusions: Results support earlier findings regarding mortality. Growth indexes are almost identical in the two groups, clarifying a previous finding of poor early growth in Kangaroo infants. Kangaroo care is associated with no excess risk of infection. It seems appropriate to recommend the KMI for populations and where health facilities are similar to ours.

Breastfeeding and breast cancer risk.

A population-based case-control study of breast cancer with a focus on premenopausal women under 45 years of age, conducted in three geographic regions of the United States, enabled the evaluation of risk in relation to varying breastfeeding practices. Among premenopausal parous women (1,211 cases, 1,120 random-digit-dialing controls), a history of breastfeeding for two or more weeks was associated with a relative risk (RR) of 0.87 (95 percent confidence interval [CI] = 0.7-1.0). This relationship was not altered substantially by removing from the reference group women who had problems with breastfeeding in the first two weeks, including those with insufficient milk production. Risk was not related substantially to number of children breastfed or length of breastfeeding, although a relatively low risk was observed among those breastfeeding for the longest duration examined (RR = 0.67, CI = 0.4-1.1 for an average period per child of 72 or more weeks). Women who began to breastfeed at a young age (< 22 years) experienced the greatest reduction in risk, but other timing parameters (e.g., interval since first or last breastfeeding) were not predictive of risk. Risks were not modified substantially by age or menopause status, although the number of menopausal subjects examined was limited. Use of medications to stop breast milk was unrelated to risk (RR = 1.04). The results of this study do not support the notion that breastfeeding substantially reduces breast cancer risk; however, this may reflect the fact that most of our study subjects breastfed only for limited periods of time (average breastfeeding per child of 30 weeks). Further studies are needed to clarify the relationship of breastfeeding to breast cancer risk, and to determine possible etiologic mechanisms underlying any observed associations.

Colonization by mutans streptococci in the mouths of 3- and 4-year-old Chinese children with or without enamel hypoplasia

This case-control study compared the prevalence and concentration of mutans streptococci (MS) in saliva between children with and without enamel hypoplasia (EHP). A total of 486 3- or 4-year-old Chinese children were initially screened for EHP, then distributed into two groups: 234 children diagnosed as having EHP were assigned to the case group; 252 who were free of EHP were included in the control group. The concentration of MS in saliva was assayed for each child. Nutritional status was deduced from body height and weight. Birth weight, prematurity, and nursing history were also determined. MS were found in 94.7% of the study population. The differences in MS concentrations were not associated with low birth weight, prematurity, length of breast feeding, or body height and weight. A statistically significant association existed between the presence of EHP and high counts of MS ( p < 0.001). High MS counts were correlated with severity of enamel defects ( p < 0.001). When the caries status of the children was controlled as the confounding factor in statistical analyses, the association between EHP and MS decreased but still remained significant ( p = 0.025). This study shows that high MS counts are correlated with EHP, suggesting that irregularities in enamel surfaces could be a contributing factor that fosters the increased colonization of MS in the mouths of children.

Child-Rearing Practices and Nursing Caries

To determine which child-rearing practices are associated with nursing caries. Cross-sectional study. Hospital-based general pediatric clinic. Sequential sample of 110 healthy children aged 18 to 36 months. Feeding practices of children, limit-setting issues, and familial dental health were determined by maternal interview. Nursing caries were diagnosed by dental examination. Nursing caries were found in 22 (20%) of the children. Ninety percent of children with and without caries were bottle-feeding at 12 and 18 months of age. Ninety-one percent of children with caries and 84% without were still drinking a nighttime bottle at 18 months (P = .33). The mothers of children with caries were found to have fewer years of education, 8.9 vs 10.8 years (P = .02), and were more likely to have eight or more cavities, 55% vs 19% (P = .002). More infants in the caries group had been breast-fed, 72% vs 46% (P = .02), although length of breast-feeding was similar, 5.4 vs 6.7 months. Fewer children with caries drank fluoridated tap water, 27% vs 54% (P = .05), but there were no differences in topical fluoride use, dental hygiene practices, or visits to the dentist. These findings fail to substantiate a straightforward relationship between child-rearing practices and nursing caries and suggest that well-designed prospective studies are needed to clarify the etiology of early caries.

Breastfeeding and the risk of sudden infant death syndrome.

The New Zealand Cot Death Study, a multicentre case-control study, was set up to identify risk factors associated with sudden infant death syndrome (SIDS). In the 3 years of the study there were 485 infant deaths classified as SIDS in the study areas and 1800 infants who were randomly selected as controls. Data were collected by parent interviews and from obstetric notes. A full set of data for this analysis was available from 356 cases and 1529 control infants. The relationship between length of any breastfeeding and SIDS was examined: 92% of the controls were initially breastfed compared to 86% of the cases. As time went by, cases stopped breastfeeding sooner than controls: by 13 weeks, 67% controls were breastfed versus 49% cases. A reduced risk for SIDS in breastfed infants persisted during the first 6 months after controlling for confounding demographic, maternal and infant factors. Infants exclusively breastfed 'at discharge from the obstetric hospital' (odds ratio [OR] = 0.52, 95% confidence interval (CI): 0.35-0.71) and during the last 2 days (OR = 0.65, 95% CI: 0.46-0.91) had a significantly lower risk of SIDS than infants not breastfed after controlling for potential confounders. We have shown a substantial association of breastfeeding with a lowered risk for SIDS. This supports the need for more positive promotion and active community support to further enhance the level and length of exclusive breastfeeding.

The relationship of attitudes, knowledge, and social support to breast-feeding.

Although more women are initiating breast-feeding, few continue for more than 1-3 months into the postpartum period. The current report studied the relationship of attitudes, social support, experimental and demographic variables, and knowledge to length of breast-feeding. A totaL of 102 women were included in the study and were followed for 1 year. Perceived attitudes toward breast-feeding, selected demographic variables, and past experiences were related to length of breast-feeding.

Effect of otitis media on development: a community-based study

Otitis media history until age 3 years was recorded for 233 children as part of the surveillance in a Community Program for Promotion of Growth and Development (PROD) conducted in a western neighborhood of Jerusalem. Recurrent otitis media (6 or more episodes) occurred more frequently among children who were of North African or Asian origin, of lower social class and maternal education, and whose duration of breast feeding was less than 26 weeks. Children with recurrent otitis media also failed the 7-month hearing test more frequently than other children. The mean Developmental Quotient score at 2 years and the mean Stanford Binet score at 3 years were statistically significantly lower among children with recurrent otitis media, even after controlling for maternal origin and length of breast feeding. These findings underscore the importance of early identification and early intervention for otitis media.