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The association between breast milk feeding and dental caries risk in children remains controversial. Moreover, it is unclear whether risk factors for caries differ between breast milk-fed and formula milk-fed infants.To investigate dental caries in 13- to 18-month-old infants receiving breast milk or formula milk feeding and associated risk factors.One hundred and sixty-six 13- to 18-month-old infants were recruited from a tertiary hospital in Bangkok, Thailand. Information on feeding practices, demographics, and potential risk factors was collected using a caregiver questionnaire. Carious lesions were identified by visual and tactile examination. The Chi-squared test, Mann-Whitney U test, and logistic regression model were used for statistical analysis.The prevalence of caries in breast milk- and formula milk-fed infants was 31.8% and 36.0%, respectively, with no statistically significant difference (p = .579). Among all children, having dental plaque deposition on more than one third of the crown (adjusted OR (aOR): 15.11%; 95% CI: 6.11-37.35) and sleeping while milk feeding (aOR: 2.20%; 95%CI: 1.01-4.77) were associated with dental caries. In subgroup analysis, however, sleeping while milk feeding increased caries risk in the formula milk-fed group only (aOR: 2.95%; 95%CI: 1.07-8.12).The type of milk feeding was not associated with dental caries, whereas dental plaque and sleeping while milk feeding increased the odds of having dental caries in this population.

Aim The aims of this systematic review were to first identify and summarise original research that compared symptoms of problematic feeding in infants with tongue tie before and after frenotomy and then evaluate the quality of measures used to assess problematic feeding. Methods CINAHL and PubMed were searched for ((tongue-tie) or (ankyloglossia)) and ((feeding) or (breastfeeding) or (bottle-feeding)) and ((frenotomy) or (frenectomy) or (frenulectomy) or (frenulotomy)). Original research reporting on feeding before and after frenotomy in infants under 1 year old was included. Results Maternal nipple pain, breastfeeding self-efficacy and LATCH scores improved after frenotomy. Few data are available on the effect of frenotomy on infant feeding. The measures used to assess infant feeding were not comprehensive and did not possess strong psychometric properties. Conclusion Literature suggests that maternal nipple pain, self-efficacy and LATCH scores improve in breastfeeding mother-infant dyads after frenotomy. However, current literature does not provide adequate data regarding the effect of frenotomy on the infant's ability to feed or which infants benefit from the procedure. Future research should utilise comprehensive, psychometrically sound measures to assess infants for tongue tie and to evaluate infant feeding to provide stronger evidence for the effect of frenotomy on feeding in infants with tongue tie.

Infants with greater temperamental negative affectivity are at higher risk for overfeeding and excess weight gain.To examine whether strategies to promote responsive bottle-feeding within WIC promoted healthier maternal feeding practices and infant weight status among infants with greater negative affectivity.Secondary analysis of data from a matched-pair cluster randomized trial. Policy, systems and environmental change (PSE) strategies to promote responsive bottle-feeding were implemented at three WIC clinics; these clinics were compared with three matched control clinics. Linear mixed models tested whether infant negative affectivity interacted with PSE strategies to predict feeding and weight outcomes when infants were 4-6 months old.Significant interactions between infant negative affectivity and PSE strategies were noted. Among infants with high negative affectivity, mothers in PSE clinics reported less frequent use of food to soothe (p = 0.009) compared with mothers in control clinics. Among infants with moderate (p = 0.008) or high (p = 0.029) negative affectivity, infants in PSE clinics had healthier weight status compared with infants in control clinics.Promotion of responsive bottle-feeding is an effective way to support WIC mothers and reduce risk for overfeeding and excess weight gain, particularly for mothers of infants with greater negative affectivity.

The use of infant formula is widespread internationally. In Australia, 55% of infants receive formula before 6 months of age, with higher rates among disadvantaged communities. Infant formula use can contribute to childhood overweight and obesity, through formula composition and feeding behaviours, such as adding cereal to bottles and parental feeding style. While information abounds to promote and support breastfeeding, formula-feeding parents report a paucity of advice and support; many rely on formula packaging for information. This study systematically searched and reviewed online resources for infant formula and bottle feeding from Australian governments, health services, hospitals, and not-for-profit parenting organisations. A comprehensive search strategy located 74 current resources, mostly for parents. Researchers evaluated the resources against best practice criteria derived from Australian government and UNICEF guidelines on six topics. They assessed how comprehensively the resources addressed each topic and whether the resources provided all the information necessary for parents to understand each topic. The mean 'comprehensiveness' rating for topics across all resources was 54.36%. However, some topics were addressed more fully than others. Information on 'discussing infant formula with health workers' and on 'preparing infant formula' was more frequently accurate and comprehensive. However, there was much less comprehensive information on 'using infant formula', including amounts of formula to feed, use of bottle teats, appropriate bottle-feeding practice and responsiveness to infant satiety cues. Over half the resources were written at an acceptable reading level.

Bottle‐fed infants are at higher risk for rapid weight gain compared with breastfed infants. Few studies have attempted to disentangle effects of feeding mode, milk composition and relevant covariates on feeding interactions and outcomes. The objective of the present study was to compare effects of breastfeeding directly at the breast versus bottle‐feeding expressed breast milk on feeding interactions. Mothers with

Summary Early gut microbial colonization is important for postnatal metabolic and immune development. However, little is known about the effects of different feeding modes (suckling versus bottle‐feeding) or microbial sources on this process in farm animals. We found that suckled and bottle‐fed newborn lambs had their own distinct gut microbiota. Results from 16S rRNA gene sequencing and qPCR showed that, compared with suckling, bottle feeding significantly increased the abundances of Escherichia/Shigella, Butyricicoccus, and Clostridium XlVa, while significantly decreased the abundance of Clostridium XI. The higher levels of Escherichia/Shigella in bottle‐fed lambs suggest that artificial feeding may increase the number of potential pathogens and delay the establishment of the anaerobic environment and anaerobic microbes. Feeding modes also affected the direct transmission of bacteria from the mother and the environment to newborns. The SourceTracker analysis estimated that the early gut microbes of suckled lambs were mainly derived from the mother's teats (43%) and ambient air (28%); whereas those of bottle‐fed lambs were dominated by bacteria from the mother's vagina (46%), ambient air (31%), and the sheep pen floor (12%). These findings advance our understanding of gut microbiota in early life and may help design techniques to improve gut microbiota and health.

The COVID‐19 pandemic and subsequent lockdown and social distancing led to changes to breastfeeding support available to women in the United Kingdom. Face‐to‐face professional support was reduced, and face‐to‐face peer support was cancelled. Anecdotal media accounts highlighted practices separating some mothers and babies in hospitals, alongside inaccurate stories of the safety of breastfeeding circulating. Meanwhile, new families were confined to their homes, separated from families and support networks. Given that we know breastfeeding is best supported by practices that keep mother and baby together, high‐quality professional and peer‐to‐peer support, and positive maternal well‐being, it is important to understand the impact of the pandemic upon the ability to breastfeed. To explore this, we conducted an online survey with 1219 breastfeeding mothers in the United Kingdom with a baby 0–12 months old to understand the impact of the pandemic upon breastfeeding duration, experiences and support. The results highlighted two very different experiences: 41.8% of mothers felt that breastfeeding was protected due to lockdown, but 27.0% of mothers struggled to get support and had numerous barriers stemming from lockdown with some stopped breastfeeding before they were ready. Mothers with a lower education, with more challenging living circumstances and from Black and minority ethnic backgrounds were more likely to find the impact of lockdown challenging and stop breastfeeding. The findings are vital in understanding how we now support those women who may be grieving their loss of breastfeeding and are affected by their negative experiences and how we can learn from those with a positive experience to make sure all breastfeeding women are better supported if similar future events arise.

The pandemic is a stressful time for everyone, including mothers and healthcare providers who are concerned about the best and safest way to feed babies born to mothers with suspected or confirmed COVID‐19. There is lack of consensus regarding mother‐infant contact, unless the mother definitely has COVID‐19 and even then there is a distinct lack of data to devise protocols for everyday clinical practice.1,2

Background Cow's milk protein allergy (CMPA) is commonly seen in children. There have been no reports of the true prevalence of CMPA in Chinese infants. The aim of this population-based study is to determine the prevalence, clinical characteristics, and outcome of CMPA in Chinese infants. Methods We carried out a prospective survey in 7 participating hospitals throughout southern China. We included infants ≤12 months of age during the survey. For those suspected of CMPA, oral food challenge with cow's milk protein (CMP) was performed. A follow-up telephone interview was conducted at 12 months after the diagnosis to assess the clinical outcome of CMPA. Results A total of 9910 questionnaire surveys were distributed and 7364 (74.3%) were returned. The eligible survey number of surveys was 6768 (91.9%). A total of 182 infants was confirmed with CMPA, including 13 with anaphylactic reactions, 28 with clinical symptoms and serum immunoglobulin E (sIgE) >3.5 IU/mL, and 141 with positive CMP challenge test. The prevalence of CMPA was 2.69%. Infants with confirmed CMPA had significantly stronger family history of either 1 or both parents with food allergy, higher Cesarean section rate, and lower rate of breastfeeding, compared with those without CMPA. At 12-month telephone follow-up of 176 CMPA infants, 136 infants (77.3%) had become tolerant to CMP. Conclusions The prevalence of CMPA was 2.69%. CMPA infants had a strong family history of food allergy and atopy. Both Cesarean delivery and formula feeding were risk factors for CMPA. At 12-month follow-up, the majority of CMPA infants had become tolerant to CMP.

Gastrointestinal symptoms, such as constipation, regurgitation and infant colic, occur in about half of infants. These symptoms are often functional, but they may also be caused by cow's milk protein allergy. We developed three algorithms for formula-fed infants, which are consensus rather than evidence-based due to the limited research available in the existing literature. CONCLUSION: We believe that these algorithms will help primary healthcare practitioners to recognise and manage these frequent gastrointestinal manifestations in infants. This article is protected by copyright. All rights reserved.

The aims of this study were to determine the prevalence of erosion in a birth cohort at 24, 36, and 48 months and to investigate risk factors for erosion.One hundred and fifty-four children from a birth cohort were followed at 24, 36, and 48 months of age.Of the 154 children examined, 0% (0/154), 7% (11/154), and 28% (40/154) had erosion detected for the first time at 24, 36, and 48 months, respectively (P0.001). A cumulative total of 51 (33%) children and 256 (8%) teeth had erosion by the age of 48 months. There were no significant associations between erosive lesions first detected at 36 months and oral hygiene behaviour, medical conditions, or dietary habits reported at the 24- or 36-month examinations (all P0.05). In contrast, erosive lesion first detected at 48 months was positively associated with the use of a feeding bottle reported at the 36-month examination (P = 0.026).The prevalence of dental erosion in young children increased with age, with clinically detectable lesions forming between 24 and 36 months of age. Erosive lesions first detected at 48 months were positively associated with the use of a feeding bottle reported at 36 months.

The review examines whether mode of feeding is associated with risk of hospitalisation for illness during infancy in developed countries. Databases were searched for published studies that included the terms 'infant feeding' and 'hospitalisation'. Six studies were included. Breastfeeding was associated with a reduced risk of hospitalisation and adjusted analyses showed mixed results. Conclusion There is no clear relationship between mode of feeding and reduction of infant hospitalisation for illness in developed countries.

Objective : This study addresses the issue of whether voluntary industry regulation has altered companies’ marketing of breast‐milk substitutes in Australia since the adoption of the World Health Organization (WHO) International Code on the Marketing of Breast‐milk Substitutes 1981. Methods : Print advertisements marketing breast‐milk substitutes were systematically sampled from the Australian Women's Weekly (AWW) magazine and the Medical Journal of Australia (MJA) for the 61 years from 1950 to 2010. Results : Breast‐milk substitute advertising in both the MJA and the AWW peaked and began declining before the introduction of the WHO Code in 1981. Although there was almost no infant formula advertising in AWW after 1975–79, other breast‐milk substitute advertising has been increasing since 1992, in particular for baby food, toddler formula and food and brand promotion. Conclusions : Companies have adopted strategies to minimise the effects of the Code on sales and profit in Australia, including increasing toddler formula and food advertisements, increasing brand promotion to the public, and complying with more limited voluntary regulatory arrangements. Implications : Comprehensive regulation is urgently required to address changed marketing practices if it is to protect breastfeeding in Australia.

Aims and objectives This study aimed to develop an applicable oral training protocol and test its effects on vital sign stabilisation in premature infants. Background Oral training improves the feeding behaviour of premature infants. However, the inconsistencies of oral training procedures in previous studies obscure the interventional effect of oral training on vital sign stabilisation in premature infants. Design True experimental design. Methods Sixty premature infants with a gestational age

Background One of the most challenging milestones for preterm infants is the acquisition of safe and efficient feeding skills. The majority of healthy full term infants are born with skills to coordinate their suck, swallow and respiration. However, this is not the case for preterm infants who develop these skills gradually as they transition from tube feeding to suck feeds. For preterm infants the ability to engage in oral feeding behaviour is dependent on many factors. The complexity of factors influencing feeding readiness has led some researchers to investigate the use of an individualised assessment of an infant's abilities. A limited number of instruments that aim to indicate an individual infant's readiness to commence either breast or bottle feeding have been developed. Objectives To determine the effects of using a feeding readiness instrument when compared to no instrument or another instrument on the outcomes of time to establish full oral feeding and duration of hospitalisations. Search methods We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 1), MEDLINE via PubMed (1966 to 22 February 2016), EMBASE (1980 to 22 February 2016), and CINAHL (1982 to 22 February 2016). We also searched clinical trials' databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. Selection criteria Randomised and quasi-randomised trials comparing a formal instrument to assess a preterm infant's readiness to commence suck feeds with either no instrument (usual practice) or another feeding readiness instrument. Data collection and analysis The standard methods of Cochrane Neonatal were used. Two authors independently screened potential studies for inclusion. No studies were found that met our inclusion criteria. Main results No studies met the inclusion criteria. Authors' conclusions There is currently no evidence to inform clinical practice, with no studies meeting the inclusion criteria for this review. Research is needed in this area to establish an evidence base for the clinical utility of implementing the use of an instrument to assess feeding readiness in the preterm infant population.

Background: The World Health Organization has identified childhood obesity as a major threat to global health. Accumulating evidence indicates that excess weight early in life is predictive of later childhood and adolescent obesity. Clinical practice guidelines for infant feeding behaviors have been developed by national and international health organizations. The relationship between these guidelines and infant weight status has not been established. Aim: To examine the relationship between weight-for-age at 1 year and adherence to four clinical practice guidelines for feeding behaviors: no bottle-to-bed, minimal juice consumption, breastfeeding throughout the first year of life, and introduction to solid food no earlier than age 4–6 months. Methods: Data were obtained from the Infant Feeding Practices Study II, a longitudinal, national survey administered by the U.S. Food and Drug Administration and Centers for Disease Control and Prevention that followed mother–infant dyads from pregnancy through 1 year postpartum. The sample was comprised of 691 infants for whom 12-month survey data were available. Results: Significant associations with weight-for-age were found for juice consumption (p= 0.003), breastfeeding during the second half of infancy (p < 0.001), and introduction to solid foods prior to age 4 months (p < 0.001). A regression model that controlled for infant and maternal characteristics demonstrated that these feeding behaviors remained significant predictors of weight-for-age at 12 months. Conclusions and Implications: Modifiable infant feeding behaviors contributed to weight-for-age at 1 year. Replication studies with economically and culturally diverse samples are needed. Further, testing longitudinal interventions that address infant feeding practices is likely to yield the evidence needed for shaping future clinical practice guidelines that reduce the risk for childhood obesity and related pediatric comorbidities.

Copyright @ 2010 The Authors. This is the accepted version of the following article: Henderson, L., McMillan, B., Green, J. M. and Renfrew, M. J. (2011), Men and Infant Feeding: Perceptions of Embarrassment, Sexuality, and Social Conduct in White Low-Income British Men. Birth, 38: 61–70, which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/j.1523-536X.2010.00442.x/abstract. Background: The views of fathers have been shown to be important determinants of infant feeding decisions, but men’s perceptions of breastfeeding and formula feeding are rarely explored. Our objectives were to address this gap and examine cultural associations and beliefs concerning infant feeding practices among men. Methods: Five focus groups were conducted with low-income men (n = 28) living in areas of social deprivation in Leeds, northeast of England, and low-income areas of Glasgow, west of Scotland. Participants were white British men, aged between 16 and 45 years, and included fathers, expectant fathers, and potential fathers. Results: Overarching themes concerning sexuality, embarrassment, and social conduct were identified across all groups. Participants perceived breastfeeding as “natural” but problematic, whereas formula feeding was mainly considered as convenient and safe. Participants without direct experience of breastfeeding assumed that it involved excessive public exposure and attracted unwanted male attention. Underpinning these fears were strong cultural associations between breasts and sexuality and anxieties concerning appropriate gender roles. Conclusions: In some communities few opportunities may occur to witness breastfeeding, and thus existing fears concerning the activity as attracting predatory male attention remain unchallenged. Perceptions of breastfeeding as a sexual activity and the dominant mass media emphasis on breasts as a sexual site may present additional obstacles to breastfeeding. Antenatal or perinatal education with men should address not only practical issues but also provide advice on tackling problems generated by wider sociocultural issues of sexuality and masculinity.

Caregivers' abilities to assess how much is in the bottle may lead to encouragement of infant bottle emptying and overfeeding. The present study assessed whether use of opaque, weighted bottles (as compared with conventional, clear bottles) improves feeding outcomes. Mothers with infants

We derive a nonparametric maximum likelihood estimate of the overall survival distribution in an illness-death model from interval censored observations with unknown status of the nonfatal event. This expanded model is applied to the re-analysis of data from a randomized trial where infants, born to women infected with HIV-1 that were randomly assigned to breastfeeding or counseling for formula feeding, were followed for 24 months for HIV-1 positivity, HIV-1-free survival, and overall survival. HIV-1 positivity, assessed by postpartum venous blood tests, is the interval censored nonfatal event, and HIV-1 positivity status is unknown for a subset of infants due to periodic assessment. The analysis demonstrates that estimation of the overall and the pre- and post-nonfatal event survival distributions with the proposed methods provide novel insights into how overall survival is influenced by the occurrence of the nonfatal event. More generally, it suggests the usefulness of this expanded illness-death model when evaluating composite endpoints as potential surrogates for overall survival in a given disease setting.

Purpose The aim of this randomized controlled study was to determine the effect of semielevated side-lying (ESL) and semielevated supine (ESU) positions, which are used to bottle-feed preterm infants, on their physiological characteristics and feeding performance. Design and Methods The sample consisted of preterm infants who were born in the 31st gestational week and below, and met the inclusion criteria. A randomization was provided in the sample group with a total of 80 infants including 38 infants in the ESL (experimental) group and 42 infants in the ESU (control) group. Both groups were compared in terms of their SpO2 values, heart rates, and feeding performances before, during, and after the feeding. The data were obtained by using a form for infant descriptive characteristics, feeding follow-up form, a Masimo Radical-7 pulse oximeter device, and a video camera. Results It was determined that the infants in the ESL group had statistically significantly higher SpO2 values (ESL: 96.77 ± 2.51; ESU: 93.48 ± 5.63) and lower heart rates (ESL: 155.87 ± 11.18; ESU: 164.35 ± 6.00) during the feeding compared to the infants in the ESU group (p

Although most women in Australia are breastfeeding their newborns on discharge from hospital many discontinue before their infants are 6 months old. Since breastfeeding is socially learned a survey of a convenience sample of 305 female and male secondary school students in the Australian Capital Territory (ACT) was carried out to ascertain knowledge and attitudes about breastfeeding. The results show that over 50% think breastfeeding is an instinct and 87% believe it is the most healthful infant feeding. Most have noticed at least 1 infant being breastfed and 64% believe themselves to have been breastfed. 80% intend to breastfeed their own children in the future. Although only 15.6% feel embarrassed to see an infant breastfeeding in the presence of non-family males it is reported as unacceptable by about 80% of the respondents. Such results have implications for the inclusion of information about breastfeeding into formal and informal education particularly if students lack models and knowledge. Primary or secondary school courses in health and nutrition could include information about the superiority of breast milk for nourishment economy and the prevention of illness and infection. Family health courses could include breastfeeding as part of child care noting its bonding characteristics. Another clear implication from this study is the political issue of whether or not a government wants its mothers to breastfeed and the legislative actions to take against the active promotion of alternatives to breastfeeding.

sheehan a., schmied v. & barclay l. (2010) Complex decisions: theorizing women’s infant feeding decisions in the first 6 weeks after birth. Journal of Advanced Nursing 66(2), 371–380. Abstract Title. Complex decisions: theorizing women’s infant feeding decisions in the first 6 weeks after birth. Aim. This paper is a report of a grounded theory study of woman’s infant feeding experiences and decisions in the first 6 weeks after birth. Background. Breastfeeding is considered the optimum method of infant feeding. Studies have identified numerous factors associated with infant feeding decisions. What remains unexplored are the mechanisms by which socio-demographic, biomedical and psychosocial factors influence infant feeding decisions. Research highlights the need for further investigation of the experiences and decision-making processes of both breastfeeding and formula-feeding women. Method. A constructionist grounded theory approach to data collection and analysis was used. Data for this study were collected and analysed between 2003 and 2004. Further data, collected in a previous study in 2000, were theoretically sampled and analysed in 2005. In-depth interviews with 37 women from various socio-demographic areas in New South Wales, Australia provided data. Findings. The core category was ‘deconstructing best’. ‘Deconstructing best’ was the infant feeding decision-making process in the first 6 weeks after birth. The process of ‘deconstructing best’ involved seven phases: planning, expecting, realizing, questioning, getting on with it, defending and qualifying. Four main categories –‘it’s really best to breastfeed’, ‘it’s the unknown’, ‘it’s not the only thing going on’, and ‘everybody’s best is different’– comprised the context within which deconstructing best occurred. Conclusion. Woman’s infant feeding decisions cannot be viewed in isolation from other post-natal experiences and needs. Infant feeding decisions will only be understood and appropriately supported when they are seen in relation to the circumstances of a woman’s life, her immediate sociocultural context and individual experience.

Identifying early risk factors for childhood obesity is critical, as weight in infancy and early childhood tracks to later periods. Continued bottle use – primarily from excess milk intake – is emerging as a potential risk factor for early childhood overweight. Over three fourths of US infants drink from bottles beyond the recommended weaning age of 12 months, and two thirds of UK infants use a bottle at 18 months. This paper is divided into three parts. Part 1 reviews the literature on beverage intake, weight and bottle use in young children. Part II describes pilot data on milk bottle use and weight in 12–60‐month‐olds, collected prior to a randomized controlled (RCT) trial of a bottle‐weaning intervention. Median daily milk bottle consumption at 12 months was 5.0 (interquartile range = 3–6). Among 12–36‐month‐olds, current users were significantly more likely to be >95th% weight‐for‐height (19% vs. 0%, P 85% weight‐for‐height (27% vs. 11%, P

AIM To evaluate studies that have used surface electromyography (sEMG) during feeding for term and preterm infants. METHOD Studies published between 1996 and 2009 were identified through databases (MEDLINE, EMBASE, CINAHL, LILACS, and SciELO) and divided into groups: term infants, preterm infants, and other situations with infants aged from 0 to 12 months. RESULTS Five studies were found for suckling in term infants, two evaluating muscular activity during feeding in preterm infants, and one dealing with other situations. Some studies revealed striking differences in activity of the masseter muscle between breastfed and bottle-fed term infants (action diminished in bottle-fed infants). For preterm infants, authors evaluated sucking and sucking bursts and pointed out an effective means of evaluating muscle behaviour during feeding. There is evidence of a similarity in activity between cup feeding and breastfeeding. INTERPRETATION Studies found in this literature review show the importance of using sEMG as a method of feeding assessment for term and preterm infants. For term infants, the masseter muscle presented greater muscular activity during breastfeeding and reduced activity during bottle-feeding. It was not possible to make comparisons between studies of preterm infants because of differences in methodological design.

Although prolonged bottle feeding with a carbohydrate-rich content is commonly agreed to be the main etiologic factor for early childhood caries (ECC), in recent years additional endogenous factors, including the composition of saliva, have been suspected as predisposing factors in children for the development of this aggressive form of dental caries. As a basis for investigating the putative involvement of salivary proteins in the etiology of ECC, a qualitative comparison of major salivary protein profiles between children with ECC and caries-free controls was performed. Saliva was collected from 30 children with ECC and, after separation by sodium dodecyl sulphate-polyacrylamide gel electrophoresis, was compared with saliva from 20 caries-free controls for the general composition of proteins by means of silver staining, glycoprotein staining, and lectin blotting. Gels and blots were analysed using densitometry, and the protein-banding patterns resulting from the individuals' samples were compared by image analysis for the presence or absence of protein bands. Dendrograms obtained after comparison of all samples showed a high degree of similarity for the experimental groups. In summary, the results attest a uniform expression of the major protein components in children's saliva, regardless of the clinical manifestation of ECC, and thus pave the way for further detailed investigations of more subtle differences in the salivary proteome.

The need for dental materials which bond to all hard tissues of the tooth is an obvious one. The technique of enamel acid etching has made adhesion to enamel possible. In addition, extensive research has allowed the development of dentine-bonding agents, materials that are claimed to bond to dentine. The first and second generation of these products, despite their early success and popularity, pose several problems, including a weak and unstable bond in the oral environment. During the last decade, a number of systems, known as the third generation of dentine-bonding agents, have been marketed. They base their bonding ability on the utilization of the organic part of a pre-treated dentine. In vitro studies have reported significantly higher bond strength, and reduced microleakage and marginal gap formation. Biocompatibility and toxicity studies have demonstrated no direct harmful effect on the pulp. Clinical trials have shown promising clinical performance. These products can offer treatment alternatives in paediatric dentistry; for example, for teeth affected by amelogenesis imperfecta or local hypoplasia, for anterior teeth extensively damaged by decay or trauma, and for teeth with hypersensitive dentine. However, the dentist should be cautious using these systems because, for most of the products, the permanence of the bond in the oral environment has not been extensively studied.

Summary. Two hundred and thirty-seven children attending four Ministry of Industry nursery schools in Phnom Penh, Cambodia, were examined. Dental caries experience, oral cleanliness and soft tissue abnormalities were determined. 149 mothers of these children were interviewed and information was gathered about infant-feeding practices, weaning age, diet after weaning, toothbrushing and dental attendance. Dental caries experience was high, and only 36% of children aged 1–4 years and 4% of those aged 5–6 years were caries free. Only 15% of mothers reported bottle-feeding, but 70% of these used sweetened canned milk in the bottle. Oral hygiene was rated as poor in 80% of children and only 10% were reported to use a toothbrush. 43% of children were reported to have experienced toothache, but only 5% had been to a dentist. Resume. Deux cent trente sept enfants de quatre ecoles maternelles dependant du Ministere de l'Industrie a Phnom Penh, Cambodge, ont ete examines. Les caries dentaries, l'hygiene orale et les anomalies des tissus mous ont ete notees. Cent quarante neuf meres ont ete questionnees et les informations obtenues ont donne des renseignements sur les habitudes alimentaires, l'âge du sevrage, le regime apres le sevrage, le brassage des dents et les consultations dentaires. Le nombre de caries etait important et seulement 36% des enfants de la 4 ans et 4% des enfants de 5 ans etaient sans caries. Seulement 15% des meres donnaient un biberon mais, pour 70% d'entre elles, avec du lait en boite sucre. l'hygiene orale etait mediocre chez 80% des enfants, 10% d'entre eux se servaient d'une brosse a dents. 43% avaient souffert de douleurs dentaires mais seulement 5% avaient consulte un dentiste. Zusammenfassung. 230 Kindergartenkinder in Phnom Penh wurden untersucht. Karies, Mundhygiene und Weichteilabnormalitaten wurden bestimmt, 140 Mutter dieser Kinder wurden befragt uber die Seuglingsernahrungsgewohnheiten, das Abstillalter, Ernahrungsgewohnheiten danach, das Zahneputzen und uber zahnarztliche Erfahrung. Der Kariesbefall war hoch und nur 36% der 1–4 jahrigen Kinder und 6% der 5–6 jahrigen Kinder waren kariesfrei. 15% der Mutter berichteten uber eine Flaschenernahrung, 70% dieser Mutter fullten gesusste Milch aus Buchsen in die Flaschen. In 80% wurde eine schlechte Mundhygiene festgestellt und nur 10% benutzten eine Zahnburste. 43% der Kinder hatten schon Zahnweh aber nur 5% waren bei einem Zahnarzt. Resumen. Un total de 200 ninos que atendian cuatro pre-escolares del Miniterio de Industria en Phnom Pen, Cambodia, fueron examinados para evaluar caries, limpieza oral y anormalidades del tejido blando. Ademas, un total de 149 madres de estos ninos fueron entrevistsdas para obtener informacion sobre alimentacion del nino, edad del destete, dieta despuěs del destete, cepillado dental y visitas al odontologo. La prevalencia de caries fue muy alta y solo 36% de los ninos de 1–4 anos de edad y 6% de los de 5–6 anos de edad estuvieron libres de caries. Solo 15% de las madres reportaron alimentacion por biberon, pero el 70% de ellas utilizaban en el biberon leche enlatada endulzada. La higiene oral fue considerada pobre en 80% de los ninos y solo 10% reporto el uso de cepillos dentales. De los ninos, 43 reporto haber tenido dolor dentario, pero solo 5% habia visitado al odontologo.

Objectives—Early childhood caries is a challenging public health problem in the United States and elsewhere; however, there is limited information concerning risk factors in very young children. The purpose of this study was to assess baseline risk factors for 18-month caries prevalence as part of a longitudinal study of high-risk children. Methods—212 children 6–24 months of age were recruited from a rural community in Iowa. Subjects were enrolled in the WIC program, which provides nutritional support for low-income families with children. Dental examinations using d1d2-3 criteria were conducted at baseline and after 18 months. Caries prevalence was determined at the frank decay level (d2-3 or filled surfaces), as well as at the non-cavitated level (d1), and combined (d1, d2-3 or f surfaces). Risk factor data were collected at baseline and after 9- and 18- months. These data included beverage consumption data, presence of visible plaque, and use of fluoride toothpaste for children as well as mutans streptococci (MS) levels of mothers and children and family socio-demographic factors. Results—128 children (60%) remained in the study after 18 months. Among these children, prevalence of d-1d2-3/f level caries increased from 9% to 77%, while d2-3/f level caries increased from 2% to 20%. Logistic regression models for baseline predictors of d2-3f caries at the 18month follow-up found presence of MS in children (OR=4.4; 95% CI: 1.4, 13.9) and sugarsweetened beverages (OR=3.0; 95% CI: 1.1, 8.6) to be the only significant risk factors. Sociodemographic factors and use of fluoride toothpaste were not significant in these models. Conclusions—Results suggest that early colonization by MS and consumption of sugarsweetened beverages are significant predictors of early childhood caries in high-risk populations.

Information on infant feeding and child development was obtained from the 1970 British Births Survey and subsequent follow-ups at five and 10 years of age. A clinically advantaged subsample of infants who were either exclusively bottle-fed or exclusively breast-fed for at least three months were selected in order to minimise biases against a disadvantaged bottle-fed group. Only in the area of educational ability and attainment were differences observed as a function of the child's feeding patterns as an infant. Higher vocabulary test scores at five years and higher British Ability Scales test scores at 10 years were significantly associated with exclusive breast-feeding for more than three months. These data support and extend results obtained in previous studies on long-term developmental differences between breast-fed and bottle-fed children.

The purpose of this investigation was to quantify normal nutritive sucking, using a microcomputer-based instrument which replicated the infant's customary bottle-feeding routine. 86 feeding sessions were recorded from infants ranging between 1.5 and 11.5 months of age. Suck height, suck area and percentage of time spent sucking were unrelated to age. Volume per suck declined with age, as did intersuck interval, which corresponded to a more rapid sucking rate. This meant that volume per minute of sucking time was fairly constant. The apparatus provided an objective description of the patterns of normal nutritive sucking in infants to which abnormal sucking patterns may be compared.

Longitudinal data from the British National Survey of Health and Development (1946 birth cohort) was used to study the extent of the influence of type of infant feeding on eventual intellectual development. The survey sample of 5362 people was selected from all live births during 1 week in March 1946 in Great Britain. Study results are presented in tabular and graphic form. There was a relationship between bottle-feeding and intellectual impairment. Scores of those individuals who were part bottle-fed and part breast-fed varied with the age at which weaning from breast to bottle occurred and were intermediate between the never breast-fed and never bottle-fed groups. Breast-feeding was more common in families of higher social class in families where either parent had received some secondary schooling in families where the parents showed more interest in the childs primary education and for lower birth rank children. When the effect of these variables was controlled the magnitude of the effect of the type of feeding variable was reduced but still substantial. (summaries in FRE GER)

SUMMARY The authors recorded the sound signals during suckle feeding of six normal infants within the first two postnatal days. The sounds were recorded onto a cassette tape-recorder from a small microphone attached to the infant's neck, then displayed on an oscilloscope and analysed by digital signal processing techniques. These displays demonstrated acoustic patterns and temporal relationships which are not otherwise audible. The method and findings are described in detail, and the method should be useful in the clinical investigation of feeding and swallowing problems associated with more subtle neurological impairment and preterm birth. RESUME Auscultation cervicale de I'allaitement chez le nouveau-ne Les auteurs ont enregistre les signaux sonores de six nouveaux-nes normaux durant l'allaitement, les deux premiers jours post-nataux. Les sons ont ete enregistres sur cassette magnetique a partir d'un petit microphone attache au cou du nourrisson, puis transmis sur oscilloscope et analyses par les procedes habituels de traitement de signal. La transcription revelait des groupements acoustiques et des relations temporelles non directement audibles. La methode et les resultats sont decrits en detail et la methode peut etre utile dans l'investigation clinique de l'allaitement et des problemes de deglutition associes a un trouble neurologique mineur ou a une naissance prematuree. ZUSAMMENFASSUNG Cervicale Auskultation wahrend des Trinkens bei Neugeborenen Die Autoren haben die Gerausche beim Trinken bei sechs gesunden Neugeborenen in den ersten zwei Tagen nach der Geburt aufgenommen. Die Gerausche wurden uber ein kleines Mikrophon, das am Hals des Kindes befestigt war, mit einem Kassettenrekorder aufgenommen, auf einen Oszillographen ubertragen und mit Hilfe einer digitalen Signalverarbeitungstechnik analysiert. Diese Aufschlusselungen zeigten akustische Muster und zeitliche Zusammenhange, die sonst nicht wahrnehmbar sind. Methode und Befunde werden genau beschrieben. Die Methode sollte bei der klinischen Untersuchung von Futterungs- und Schluckproblemen in Verbindung mit subtilen neurologischen Storungen und Fruhgeburt eine Hilfe sein. RESUMEN Auscultacion cervical en la succion de alimento en los recien nacidos Los autores registraron las senales acusticas durante la succion de alimento en seis lactantes normales en el curso de los dias postnatales. Los sonidos se registraron en un cassette a partir de un pequeno microfono fijado al cuello del nino y luego observados en un osciloscopio y analizados por tecnicas de procesamiento de senal digital. De esta forma se demostraron patrones acusticos y relaciones temporales que de otra forma no son audibles. Se describen con detalle el metodo y los hallazgos. El metodo seria util en la investigacion clinica de la deglucio y de los problemas de ella y de la alimentacion, asociados con alteraciones sutiles neurologicas y con el nacimiento pretermino.

The maturation of deglutition apnoea time was investigated in 42 bottle-fed preterm infants, 28 to 37 weeks gestation, and in 29 normal term infants as a comparison group. Deglutition apnoea times reduced as infants matured, as did the number and length of episodes of multiple-swallow deglutition apnoea. The maturation appears related to developmental age (gestation) rather than feeding experience (postnatal age). Prolonged (> 4 seconds) episodes of deglutition apnoea remained significantly more frequent in preterm infants reaching term postconceptual age compared to term infants. However, multiple-swallow deglutition apnoeas also occurred in the term comparison group, showing that maturation of this aspect is not complete at term gestation. The establishment of normal data for maturation should be valuable in assessing infants with feeding difficulties as well as for evaluation of neurological maturity and functioning of ventilatory control during feeding.

Objectives: Dental caries is the most common chronic disease in US children. Early childhood caries (ECC) is particularly virulent and can interfere with a child's ability to eat, grow, speak, and communicate. Studies on whether breast-feeding or bottle-feeding are more likely to reduce ECC have proven inconclusive. Methods: The study population included 175 children, aged 1 to 5, receiving dental care at the Hughes Spalding Children's Hospital in Atlanta, GA. Participation included a dental exam, chart data abstraction, and a personal interview with the mother. Results: Too few exclusively breast-fed children prevented the adequate study of breast-feeding. However, children exclusively bottle-fed for at least 1.5 years had more decayed or filled tooth surfaces than children breast-fed part of that time but well short of a year. No bottle at night nor juice at irregular times, the mother's brushing of her child's teeth, and adequate dental care in the mother seemed to reduce ECC. Conclusions: Our results suggest measures that might reduce ECC risk. Medical providers must discuss oral health with new mothers and educate them on the important role they play in keeping their babies' teeth healthy.

Objectives: To investigate the impact of feeding habits and daytime sugar intake on the prevalence of early childhood caries in a population where prolonged breastfeeding is a norm. Methods: A cross-sectional study was carried out at 18 of 102 public health centers in Tehran. During a 4-day period at each center, between 20 and 35 children aged 1-3 years were enrolled, resulting in a sample of 504 children. In structured interviews, mothers were asked to give information about their child's feeding habits, daytime sugar intake, and their family's background. Sugar intake during the night was operationalized as separately calculated burdens of nighttime breastfeeding and bottle-feeding. Clinical dental examinations followed the World Health Organization criteria. Data analysis included chi-square test, t-test, anova, and logistic regression modeling. Results: Of the children, 56% were solely breastfed (mean duration 16.6 months; 95% CI 16.0-17.2), 42% were both breastfed and bottle- fed, and 2% were solely bottle-fed. Mean duration of breastfeeding for the solely breastfed 24- to 36-month olds was 22.8 months (95% CI 21.8-23.9). At bedtime, 69% were breastfed, 11% bottle-fed, and 20% were not fed at all. With respect to feeding during the night, 72% of children were breastfed, 12% were bottle-fed with milk, 1% received a bottle with water, while 15% were not fed. Early childhood caries (ECC) occurred in 3-26% of the children, depending on age group (P < 0.001). The burden of milk-bottle feeding at night was a clear determinant for ECC (OR = 5.5) whereas breastfeeding per se, its duration, the burden of breastfeeding at night, and daytime sugar intake were not. Conclusion: On account of its association with ECC, milk-bottle feeding at night should be limited, whereas prolonged breastfeeding appears to have no such negative dental consequences.

Background: Approximately 40 percent of women smokers will stop smoking cigarettes during pregnancy; however, 70 percent of those who stop will resume smoking by 6 months postpartum. This exploratory pilot study prospectively examined the timing and predictors of returning to smoking after pregnancy in a group of inner-city women who stopped smoking cigarettes during pregnancy. Methods: We interviewed women who stopped smoking just before or during their pregnancies during their postpartum hospital stay and at their infants’ 2-week health supervision visits. Urine cotinine levels were measured at each interview. Results: Forty-nine women were interviewed during the postpartum stay and 37 women at the 2-week follow-up. At follow-up, 40.5 percent (n = 15) of women had returned to smoking. Mothers more frequently returned to smoking if they had a lower level of education, that is, high school graduate/general equivalency diploma versus some college education (13/24 vs 2/13, p < 0.04); if they had someone else in the household who smoked (14/23 vs 1/14, p < 0.003); if they were formula feeding their infant at the time of interview (14/24 vs 1/13, p < 0.005); if they discussed smoking with a doctor or nurse during pregnancy (12/20 vs 3/17, p < 0.02); and if they were African American (10/15 vs 5/22, p < 0.02). Mothers reported the primary reasons for returning to smoking were stress (53%, n= 8) and being around another smoker (40%, n= 6). Conclusions: Almost one-half of the women in this pilot study who stopped smoking cigarettes during pregnancy resumed in the days immediately after delivery. These data suggest that future studies should explore the initiation of postpartum relapse prevention during the prenatal and perinatal period. Interventions may be more effective if they include strategies aimed increasing breastfeeding rates and assisting household members to stop smoking. (BIRTH 34:3 September 2007)

Early childhood caries (ECC) has not been adequately investigated in Israel. A previous Jerusalem study has demonstrated a potential effect on toothbrushing among infants. The present study was initiated in order to examine caries prevalence and the potential effect of a community intervention program. Objectives: This study aims to review an intervention program and assess ECC distribution and associated variables. Methods: The study sample included 1,500 infants in matched “intervention” and “control” Mother and Child Health centers. The 2-year program, initially including all children at the age of 6 months, focused on the free distribution of toothbrushes and toothpastes. ECC prevalence was determined in a cross-sectional study. Results: At 2.5 years, 596 children were examined (40 percent compliance). About half of the parents reported that they had participated once or not at all over the 2-year period, which demonstrated low program participation. Among the examined children, ECC prevalence was 15.3 percent. No difference in caries levels was found between the program and control groups. The reported level of brushing twice daily was 13.9 percent, while 26.8 percent reported not brushing at all. Eighty-one percent reported going to bed at night with a bottle. Children who drank sugar-sweetened beverages had ECC levels significantly higher than those who drank milk or natural juice (18.8 percent versus 8.9 percent). Conclusions: The dental health and behavior and lack of intervention success emphasized the need to seek a more effective strategy. Emphasis on toothbrushing might not be the only nor optimal solution for this serious public health problem.

Nucleotides (NT) and their related metabolic products play key roles in many biological processes. NT can be synthesized endogenously and thus are not considered essential nutrients. Studies have demonstrated, however, that dietary NT can have beneficial effects; the term "conditionally essential" has been used to describe their role in human nutrition. These nutrients may become essential when the endogenous supply is insufficient for normal function, even though their absence from the diet does not lead to a classic clinical deficiency syndrome. Most dietary NT are rapidly metabolized and excreted. However, some are incorporated into tissues, particularly at younger ages and with fasting. Under conditions of limited NT intake, rapid growth or certain disease states, dietary NT may spare the cost of de novo NT synthesis and optimize the function of rapidly dividing tissues such as those of the gastrointestinal and immune systems. Animals fed NT-supplemented versus non-NT supplemented diets have enhanced gastrointestinal growth and maturation, and improved recovery following small and large bowel injury. Indices of humoral and cellular immunity are enhanced, and survival rates are higher following infection with pathogens. Infants receive NT in human milk, where they are present as nucleic acids, nucleosides, nucleotides and related metabolic products. The NT content of human milk is significantly higher than most cow's milk-based infant formulae. Dietary NT are reported to enhance the gastrointestinal and immune systems of formula-fed infants. Infants fed NT-supplemented versus non-supplemented formula have a lower incidence of diarrhea, higher antibody titers following Haemophilus influenzae type b vaccination and higher natural killer cell activity. These data suggest that human milk NT may contribute to the superior clinical performance of the breastfed infant.

Human milk is the preferred feeding for all infants, including premature and sick newborns, with rare exceptions. However, modern technology has produced alternative, "humanized formulae", which closely mimic the composition of human milk. The ingestion of human milk, "humanized formulae" or whole cow's milk has consequences for human nutrition. Gastroesophageal reflux, iron deficiency, calcium and sodium excesses or deficiencies may be influenced by the type and amount of milk fed to the infant. Likewise, neurological development and the likelihood of developing diabetes or cancer may also be influenced by early dietary practices. Until new information is available, we should continue to pattern formulae for older infants after breast milk, but with sufficient protein, calories, lipid and minerals to support optimal growth.