Hugo Issler

Early weaning: implications to oral motor development

OBJECTIVE This article aims at reviewing the relationship between early weaning and its consequences to oral motor development, focusing on the consequences to occlusion, breathing, and childrens oral motor aspects. SOURCES A literature review based on Medline database from the early 60s up to 2001 was performed taking into consideration the following topics: pediatrics, dentistry and speech language pathology. SUMMARY OF THE FINDINGS Based on this review of literature, we could verify that early weaning may lead to a proper oral motor development rupture, which may cause negative consequences to swallowing, breathing and speaking activities as well as malocclusion, oral breathing and oral motor disorders. CONCLUSIONS In addition to several benefits of breastfeeding, it contributes to a proper oral motor development and also avoids speech-language disorders, regarding oral motor system.

Risk factors for atherosclerosis in children and adolescents with family history of premature coronary artery disease

OBJECTIVES To identify the prevalence of dyslipidemia in a group of 109 children and adolescents with a family history of premature coronary artery disease and to investigate the association between dyslipidemia and other risk factors for atherosclerosis. METHODS Total cholesterol, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglycerides, body mass index, blood pressure, physical activity, smoking, per capita income and maternal schooling were investigated. RESULTS Total cholesterol and LDL-C levels were higher than desirable in 27.5% and 19.3%, respectively, of our patients; 13.8% had lower HDL-C values and 13.0% presented hypertriglyceridemia. Obesity and excess weight were observed in 25.7% of the cases. Out of these, 57.1% had abnormal lipid values. Dyslipidemia was observed in 38.5%, either alone or in combination with other risk factors. Smoking was observed in 3.6%, hypertension in 2.7% and physical inactivity in 72.5%. There was no relationship between dyslipidemia and per capita income, maternal schooling and physical inactivity. However, obesity and excess weight were identified as significantly associated with the occurrence of dyslipidemia (p = 0.02; odds ratio = 2.82, 95% CI = 1.6-6.81). CONCLUSION In children and adolescents with a family history of premature coronary artery disease, early identification of the risk factors for atherosclerosis is essential to allow the implementation of preventive measures.

Breastfeeding: making the difference in the development, health and nutrition of term and preterm newborns

Breastfeeding is the natural and safe way of feeding small infants, providing nutritional, immunological, psychological and economic recognized and unquestionable advantages. These qualities are especially important in premature infants, because of their vulnerability. Despite highly desirable, there is, in general, little success in breastfeeding preterm infants, especially in special care neonatal units. There are evidences that a high supportive hospital environment, with an interdisciplinary team, makes possible to these infants to be breastfed. In this article, the authors present an up-to-date review about the components of human milk and its unique characteristics, as well as describes aspects that make the breast milk particularly suitable for feeding the premature newborn.

Exclusive Breastfeeding in Southern Brazil: Prevalence and Associated Factors

BACKGROUND Worldwide strategies have been conducted in order to guarantee longer periods of exclusive breastfeeding for most children, especially those from developing countries. The evaluation of infant feeding practices and the identification of weaning risk factors are essential for public health policy planning. METHODS This cross-sectional study was carried out in Joinville, the biggest city of Santa Catarina State in the southern Brazilian region. The caregivers of children under 1 year of age were systematically selected for interview in previously drawn immunization units during the 2005 National Vaccination Campaign. A structured questionnaire was applied for collection of infant, maternal, and healthcare variables. A 24-hour food recall survey was included in order to evaluate infant feeding practices. Descriptive statistic analysis on breastfeeding prevalence and Poisson regression analysis of risk factors for discontinuing exclusive breastfeeding for infants up to 6 months of age were performed. RESULTS Caregivers of 1,470 infants were interviewed. The feeding inquiry showed an overall rate of breastfeeding of 72.5% and a frequency of exclusive breastfeeding of 43.7% and 53.9% among infants younger than 6 and 4 months of age, respectively. The findings associated with the interruption of exclusive breastfeeding for infants up to 6 months were: higher infant age (P < 0.001), pacifier use (P < 0.001), and lower maternal educational level (P = 0.013). CONCLUSIONS In developing countries, specific strategies must be created for the delivery of information about breastfeeding and the effect of pacifier use, especially for less educated women.

Breastfeeding the Premature Infant: Experience of a Baby-Friendly Hospital in Brazil

Breastfeeding is the natural way of feeding infants, providing nutritional, immunological, psychological, and economic advantages. These qualities are especially important in premature neonates because of their vulnerability. Nevertheless, a lower incidence of successful breastfeeding has been observed in this population. This prospective study investigated the frequency of mother’s milk use on discharge of premature neonates from an at-risk neonatal unit. It involved 244 premature neonates and took place at a Brazilian Baby-Friendly Hospital. The observed frequency of mother’s milk use at neonatal unit discharge was 94.6%. The finding that most premature neonates were receiving mother’s milk reflects a well-structured program for promoting breastfeeding of premature neonates at this institution, which relies on an interdisciplinary team to provide adequate support to the mothers.

Aleitamento materno exclusivo em lactentes atendidos na rede pública do município de Joinville, Santa Catarina, Brasil

OBJECTIVES: to identify the prevalence of exclusive breastfeeding in children attending the public health system and its association with variables relating to the mother and the child. METHODS: cross-sectional study conducted in the course of the 2005 National Immunization Campaign, in the city o Joinville, State of Santa Catarina, Brazil. Carers for 889 children answered a questionnaire including questions about the mother and the child at the vaccination sites. Descriptive statistics and chi-square test were used to analyze data, with a level of significance of 5%. RESULTS: the observed prevalence for breastfeeding was 90.7%, 84.2% and 73.5%, in children under four, six and twelve months of age, respectively. Exclusive breastfeeding rates were 53.9% among children under four and 43.6% among those under six months. Use of pacifiers was significantly associated with the absence of exclusive breastfeeding both in children under four and in those under six months of age (p<0.001). Mother work outside home was associated with the absence of exclusive breastfeeding in children aged under six months (p=0.001). CONCLUSIONS: exclusive breastfeeding rates among infants under 12 months of age attending public health system were lower than those recommended by the World Health Organization. The use of pacifiers and the mother work may negatively influence exclusive breastfeeding.