Search

Maternal educational attainment has been identified as relevant to several child health and development outcomes. This study aimed to evaluate the association of sociodemographic and maternal education factors with child development in families living below the poverty line. A cross-sectional study was conducted through telephone contact from May to July 2021 in Ceará, a state in Northeastern Brazil. The study population comprised families with children up to six years of age participating in the cash transfer program "Mais infância". The families selected to participate in this program must have a monthly per capita income of less than US$16.50. The Ages and Stages Questionnaire version 3 was applied to assess the children's development status. The mothers reported maternal educational attainment as the highest grade and or degree obtained. The final weighted and adjusted model showed that maternal schooling was associated with the risk of delay in all domains except for the fine motor domain. The risk of delay in at least one domain was 2.5-fold higher in mothers with a lower level of schooling (95% CI: 1.6–3.9). The findings of this study suggest that mothers with higher educational attainment have children with better child development outcomes. [ABSTRACT FROM AUTHOR]

Objective: to analyze the factors that influence the practice of nurses in childcare consultation in Primary Care. Method: cross-sectional study with 31 Family Health nurses from a municipality in the Northeast of Brazil, using a checklist with care dimensions implemented in childcare. For data analysis, descriptive statistics and Mann-Whitney test were used. Results: the consultations performed by nurses with graduation completion time and working time of up to ten years presented a care focused on the dimensions of embracement, anamnesis and evaluation of the vaccination status and supplementation. While those with more than ten years prioritized the evaluation of growth and records in the medical record and in the Child's Handbook. There was a significant association between female gender and specialization with the performance of professionals. Conclusion: the factors that influence the practice of nurses in childcare cause important differences in care, and may compromise the completeness of child care. [ABSTRACT FROM AUTHOR]

Copyright of Texto & Contexto Enfermagem is the property of Universidade Federal de Santa Catarina, Programa de Pos-Graduacao de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To compare neonatal eye screening using the red reflex test (RRT) versus the wide‐field digital imaging (WFDI) system. Methods: Prospective cohort study. Newborns (n = 380, 760 eyes) in the Maternity Ward of Irmandade Santa Casa de Misericórdia de São Paulo hospital from May to July 2014 underwent RRT by a paediatrician and WFDI performed by the authors. Wide‐field digital imaging (WFDI) images were analysed by the authors. Validity of the paediatrician's RRT was assessed by unweighted kappa [κ] statistic, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: While WFDI showed abnormalities in 130 eyes (17.1%), RRT was only abnormal in 13 eyes (1.7%). Wide‐field digital imaging (WFDI) detected treatable retina pathology that RRT missed including hyphema, CMV retinitis, FEVR and a vitreous haemorrhage. The sensitivity of the paediatrician's RRT to detect abnormalities was poor at 0.77% (95% confidence interval, CI, 0.02%–4.21%) with a PPV of only 7.69% (95% CI, 1.08%–38.85%). Overall, there was no agreement between screening modalities (κ = −0.02, 95% CI, −0.05 to 0.01). The number needed to screen to detect ocular abnormalities using WFDI was 5.9 newborns and to detect treatable abnormalities was 76 newborns. Conclusion: While RRT detects gross abnormalities that preclude visualization of the retina (i.e. media opacities and very large tumours), only WFDI consistently detects subtle treatable retina and optic nerve pathology. With a higher sensitivity than the current gold standard, universal WFDI allows for early detection and management of potentially blinding ophthalmic disease missed by RRT. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The early identification of developmental delay in adolescents by health professionals is relevant for a good prognosis. However, the clinical indicators of development delay are unclear in nursing science. PURPOSE: To analyze the clinical indicators of delayed development in school adolescents. METHODS: A diagnostic accuracy study that investigated delayed development among 385 adolescents in public schools between July and September of 2017. The accuracy measures were analyzed using a latent class analysis based on sensitivity and specificity values. FINDINGS: The delayed development is present in 18.26% of school adolescents. The best accuracy values were as follows: low self‐esteem (0.9838), dissatisfaction with own image (0.8400), impaired daily activities (0.9815), internalization behavior (0.8304), outsourcing behavior (0.6367), eating disorders (1.0000), emotional insecurity (0.7093), dependent behavior (0.9836), and altered sexual maturation (0.6085). CONCLUSION: Thus, this set of nine clinical indicators can be used by nurse practitioners to confirm delayed development in school adolescents. IMPLICATIONS FOR NURSING PRACTICE: This research contributes by providing accurate clinical indicators of delayed development in adolescents. Thus, nurses should recognize delayed development in adolescents through accurate clinical indicators and propose nursing interventions that have positive health results. [ABSTRACT FROM AUTHOR]

Copyright of Avances en Enfermería is the property of Editorial Universidad Nacional de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Understanding the morphologic alterations of the human face over the time is an essential step towards optimal simulations of facial age progression. In practice, these simulations contribute to the forensic routine by tracking and recognizing missing persons. Objective: This study aimed to assess the morphometric facial alterations with aging -- concerning specifically the development of ear, nose and lip in relation to other facial structures. Material and methods: The sample consisted of 700 photographs taken standardly in frontal view from male and female Caucasian subjects aged from 20 to 80 years old. The sample was divided in 7 age groups (20, 30, 40, 50, 60, 70 and 80 years old), in which 50 males and 50 females were distributed homogenously. Photoanthropometric analysis was applied with SAFF 2D® 2.0.05 (SEPAEL/INC, Federal Police, Brazil) software package considering 36 facial landmarks. A single examiner analyzed the sample aided by two other examiners for the assessment of intra-/inter-rater reliability. Results: The most evident alterations found in the facial structures consisted of the enlargement of the nose and ears with aging, as well the reduction in size of the lip thickness. These alterations varied considerably in the specific age ranges studied in this research being different between males and females. Conclusion: The present outcomes indicated the possibility of quantifying morphometric alterations observed in the human face with aging. These alterations may support the forensic practice providing tools for age estimation based on photographic analyses. [ABSTRACT FROM AUTHOR]

Copyright of Brazilian Journal of Occupational Therapy / Cadernos Brasileiros de Terapia Ocupacional is the property of Cadernos de Terapia Ocupacional da UFSCar and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To apply Demirjian's seven (1973, D 7 ) and four (1976, D 4 ) teeth methods in a sample of Brazilian children and compare their performances for age estimation. Panoramic radiographs of 1200 children (600 females and 600 males) were collected from Southeast Brazil. The children were equally distributed (n = 60 females and 60 males) between age intervals of 1 year between 6 and 15.9 (mean age = 10.9; standard deviation [SD]: 2.9) years. D 7 and D 4 dental age estimation methods were applied by two observers and were compared based on their error rates (error = estimated age-chronological age). Both methods overestimated the chronological age (p < 0.0001). D 7 led to overestimations of 0.71 (p < 0.0001) in females and 0.83 (p < 0.0001) in males, while the overestimations with D 4 were 0.14 (p = 0.0067) and 0.73 (p < 0.0001) for females and males, respectively. The mean age estimated by D7 was 11.7 (SD: 3.1) years, while for D4, it was 11.3 (SD: 3.3) years. Intra- and interobserver agreement was ≥ 0.98. D 4 optimized the performance of radiographic dental age estimation compared to D 7 . Improvements were reflected in the total sample and separately for female and male children from Southeast Brazil., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background Infant developmental delays have been associated with several risk factors, such as familial environmental, individual and demographic characteristics. The goal of this study was to longitudinally investigate the effects of maternal knowledge and practices, home environment and biological factors on infant motor and cognitive outcomes. Methods This was a prospective cohort study with a sample of 49 infants from Southern Brazil. The infants were assessed three times over 4 months using the Alberta Infant Motor Scale and the Bayley Scale of Infant Development (Mental Development Scale). Parents completed the Daily Activities Scale of Infants, the Affordances in The Home Environment for Motor Development - Infant Scale, the Knowledge of Infant Development Inventory and a demographic questionnaire. Generalized estimating equation with Bonferroni method as the follow-up test and Spearman correlation and multivariate linear backward regression were used. Results Cognitive and motor scores were strongly associated longitudinally and increased over time. Associations between the home affordances, parental practices and knowledge, and motor and cognitive development over time were observed. This relationship explained more variability in motor and cognitive scores compared with biological factors . Conclusions Variability in motor and cognitive development is better explained by environment and parental knowledge and practice. The investigation of factors associated with infant development allows the identification of infants at risk and the implementation of educational programs and parental training to minimize the effects of developmental delay. [ABSTRACT FROM AUTHOR]

Copyright of Revista Gaucha de Enfermagem is the property of Revista Gaucha de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article aims to show the role of financing in economic development in two countries, Brazil and Mexico, after World War II (WWII) to present day. We do a careful historical review to see what sort of policies and what kind of structure two national development banks (Nacional Financiera [NAFINSA] from Mexico and Banco Nacional de Desenvolvimento Econômico e Social [BNDES] from Brazil) carry out in order to spark industrialization. Our research shows that these banks were successful at promoting growth (but not human development) in particular periods in their country's history (import substitution) and not successful in other periods (neoliberalism). [ABSTRACT FROM AUTHOR]

Objective: Suspicion of early anterior fontanel (AF) closure is a common reason for referral to a pediatric neurosurgeon because of the suspected increased risk of developing craniosynostosis (CS) in spite of the absence of evidence in the literature. The aim of this study was to analyze the association between AF closure and the diagnosis of non-syndromic CS in Brazilian children., Methods: An observational and case-cohort study was conducted to compare the incidence of closed AF between healthy children (group 1) and children diagnosed with non-syndromic CS (group 2) at a pediatric neurosurgery referral center. The accuracies of completely closed AF and diagnosis of CS were assessed., Results: High-resolution three-dimensional reconstruction computed tomography scans were obtained for 140 children aged < 13 months, of whom 62.9% were boys and 37.1% were girls (p < 0.001). The most common types of non-syndromic CS were trigonocephaly (34, 48%) and scaphocephaly (25, 35.7%). Closed fontanel (27, 38.6%) was observed in both groups, and a sensitivity of 36.1%, specificity of 72%, the positive predictive value of 59%, and negative predictive value of 51% were observed in the patients diagnosed with CS when AF closure occurred before the age of 6 months., Conclusion: The results of this comparative study of AF closure and CS diagnosis suggest that early AF closure does not imply a diagnosis of CS. Pediatricians should be aware of the risk of misdiagnosis of CS in cases with a widely open AF in spite of the presence of CS., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2022 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Objective: To analyze the impact of the covid-19 pandemic on the use of primary health care services to follow-up the child growth and development in Brazil., Method: A total of 7.9 million consultations of children (0-2 years old) across Brazil between March 2017 and May 2020 were studied. Differences between medians were analyzed using non-parametric tests, the Global Moran Index (IGM) and the Local Indicators of Spatial Association., Results: During the initial period of the pandemic, the median number of consultations was significantly lower than the same period in previous years, reducing more than 50%. The drop in 2020, compared to 2019, ranged from 49% to 62.2% across all regions of the country, except the South. The percentage reduction registered in 2019-2020 showed significant spatial autocorrelation (IGM = 0.20; p = 0.04), with the presence of low-low (states with reduction between 29% and 51%) and high-high (states with reduction between 55% and 69%) spatial clusters., Conclusion: The covid-19 pandemic impacted the follow-up of child growth and development in primary health care services in Brazil, with a geographically uneven reduction.

Background: Osgood-Schlatter (OS) syndrome is a disease of the musculoskeletal system often observed during the bone growth phase in adolescents.Hypothesis/Purpose: Demographic and anthropometric factors and those linked to the practice of sports may be related to the prevalence of OS. The aim of the present study was to describe the epidemiologic profile and associated factors of individuals with OS syndrome in a population-based sample of Brazilian adolescents.Study Design: Cross-sectional study; Level of evidence, 3.Methods: A cross-sectional study was conducted with 956 adolescent students (474 boys, 482 girls) from 2008 to 2009 enrolled in the school system of Natal, Brazil. The age ranged between 12 and 15 years (13.7 ± 1.04 years). Tests were performed to assess the anthropometric and clinical aspects related to OS. To confirm the diagnosis of OS syndrome, the participant had to fulfill all the following clinical criteria: pain with direct pressure on the tibial apophysis; aforementioned pain before, during, and after physical activities; enlargement or prominence of the tibial apophysis; pain with resisted knee extension; and pain from jumping.Results: The prevalence of OS in the sample was 9.8% (11.0% of boys and 8.3% of girls; boys, 13.5 ± 1.07 years; girls, 13.6 ± 1.01 years). The results showed that 74.6% of the students suffered from muscle shortening. Multivariate analysis using logistic regression showed that the factors associated with the presence of OS were the regular practice of sport activity (odds ratio, 1.94; 95% confidence interval, 1.22-3.10) and the shortening of the rectus femoris muscle (odds ratio, 7.15; 95% confidence interval, 2.86-17.86).Conclusions: The regular practice of sports in the pubertal phase and the shortening of the rectus femoris muscle were the main factors associated to the presence of OS syndrome in the students. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyse chronological, morphologic and functional markers of students in the city of Mossoró-RN, in Brazil, taking into account the maturational stages. The study was classified as a descriptive comparative research. The sample was composed of 305 children divided in two groups: n = masculine 153 and n = feminine 152, from nine to 17 years. The protocols used were Body Mass Index, Skinfolds addiction, horizontal jump and the 30 m test. We used a descriptive statistical analysis. The results pointed to a development that will always be linked to the growth. The existence of behavior of modification of the studied variables, into a chronological way, but with the maturational cut, consists in an interesting strategy of observation, and it permit to take in account the natural intervention of the growth and development of the individuals. So, it is recommended that not only the chronological behavior of the intervening variables in the growth and human development be taken in account, but the maturacional behavior, as well as, the use of instruments of hereditary and genetic indication. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to evaluate the effect of Kangaroo Position (KP) in microcirculation (MC) of the flexor muscles of preterm newborns., Method: A controlled clinical trial was conducted in the city of Recife, Brazil, with 26 preterm children randomized in the Kangaroo Group (13) and in the Control Group (13). Assessments of blood flow, temperature, and tissue oxygen saturation (SO 2 ) were made at two different times and in the biceps brachii muscle and hamstrings muscle group: before the KP and after 24 h of KP. In the Control Group, the registrations were performed at the times corresponding to those of the Kangaroo Group. The mean values among the times were analyzed by paired t-test for repeated measures. The clinical trial was recorded in Clinical Trials (NCT03611088)., Results: In the Kangaroo Group there was an increase in tissue temperature and blood flow at the time evaluation periods (p < 0.05). In the control group, there was no statistical difference between the recording moments hamstring muscles group, but in the biceps brachii, there was a reduction in mean blood flow (p = 0.023)., Conclusion: In conclusion, the KP has effects on the microcirculation of the flexor muscles of preterm newborns., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2021. Published by Elsevier Editora Ltda.)

Introduction: Developmental Defects of Enamel (DDEs) comprise qualitative and/or quantitative changes to the enamel during amelogenesis. The aetiology of DDE remains inconclusive., Aim: To determine the association of pre, peri, and postnatal factors with the presence of DDE., Design: Cross-sectional study with 353 children (8 to 11 years-old) in a Brazilian town., Methods: One calibrated dentist assessed DDE using the Developmental Defects of Enamel Index and a questionnaire collected medical and sociodemographic data., Main Outcomes: Children with at least one type of DDE were categorized into the DDE group. Subtypes of DDE were also recorded., Results: 63.1% of children had at least one type of DDE. Diffuse opacity was present in 36.7%, demarcated opacity in 14.8%, and hypoplasia in 5.83% of the children. In multivariate analysis, demarcated opacities and hypoplasia were associated with birth weight ⟨ 2500g (OR = 4.82; 95% CI 1.23-1.95)., Conclusion: Low birth weight predicted DDE., (Copyright© 2021 Dennis Barber Ltd.)

Introduction: Newborn who had Zika vírus but did not show microcephaly at birth may have neuropsychomotor development problems. We aimed to evaluate the developmental and anthropometric milestones of asymptomatic children whose mothers had Zika during pregnancy in Northeastern Brazil in 2015 and 2016., Methods: We conducted a descriptive cross-sectional case series study of children in Fortaleza born without microcephaly whose mothers had Zika during pregnancy. Home visits were undertaken to evaluate the developmental milestones and gather anthropometric data of the children and to conduct semi-structured interviews with the mothers to identify their socioeconomic and gestational profiles and assess the newborns after birth., Results: In total, 30 cases were identified. Of these, 17 children and their mothers participated in the study. The median age of the mothers at the time of delivery was 26 years. All were symptomatic, and TORCH was negative. At the time of the home visit, all had growth profiles suitable for their age. However, nearly all children (15/17, 88.2%) presented at least one developmental delay, considering their age group., Conclusions: There were late changes in the neuropsychomotor development of children born to mothers who had Zika during pregnancy, suggesting the need for specialized medical follow-ups.

Objectives: To review the scientific literature of studies on dental age estimation methods applied to Brazilian children., Methods: A systematic literature review was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (CRD42020136170). Six scientific databases were used as primary search sources (PubMed, Scopus, LILACS, SciELO, Embase and Web of Science) and two databases (Open Grey and Open Thesis) were searched to partially select the "grey literature." Only cross-sectional studies were included. The risk of bias was assessed by means of Joanna Briggs Institute Critical Appraisal Tools for Systematic Reviews. The standardized mean difference (SMD) between the estimated dental and chronological ages was meta-analysed via random effects model., Results: The search resulted in 2,527 studies, from which 13 met the eligibility criteria. Out of the eligible studies, 76.92% had low risk of bias and high methodological quality. Ten studies provided proper information to be included in the meta-analysis.The methods and their SMD between estimated and chronological ages were: Willems'=0.05, Lilequist and Lundberg' s = -0.11, Nolla' s = 0.22, Mornstad' s = 0.27, Cameriere' s = -0.31, Demirjian' s = 0.74 and Haavikko' s = -0.87., Conclusion: Although originally trained in populations worldwide, most of the international methods for radiographical dental age estimation had optimal performance in Brazilian children.

Purpose: This study aims to analyse the accuracy of clinical indicators of the proposed diagnosis of delayed growth in school-aged adolescents., Design and Methods: This is a diagnostic accuracy study of 385 adolescents in public schools from July to September 2017 that aimed to assess the accuracy of clinical indicators of the proposed nursing diagnosis of delayed growth; the sensitivity and specificity values were calculated using latent class analysis., Results: Growth velocity less than expected was associated with sensitivity and specificity. The clinical indicator short stature for age and sex showed sensitivity. Low weight for age and sex, stature below genetic target and delayed sexual maturation were specific indicators., Conclusion: In a sample of adolescents in public schools in northeastern Brazil, a set of five clinical indicators best indicated delayed growth in adolescents. Two clinical indicators showed sensitivity, and four clinical indicators showed specificity., Practice Implications: This study contributes to refining the diagnostic proposition of delayed growth in adolescents. Accurate measures for nursing diagnoses can help paediatric nurse practitioners confirm or exclude this diagnosis in adolescents with a similar profile., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The outbreak of Zika virus in Latin America in the period 2015⁻2016 has caused a sudden increase in the number of severe manifestations and reports of congenital changes in newborns in Brazil. This is the first study that evaluated and compared the growth and cognitive and motor development of children with microcephaly due to Congenital Zika Virus Syndrome (CZS) in relation to typical children. It was an observational, analytical, cross-sectional study with 8 children with CZS and 16 typical children, with a mean age of 20.5 months (±2.1), in a region of northeastern Brazil. Considering the mean, children with CZS presented extremely low performance in the motor domain and in the cognitive development domain, whereas typical children presented average performance in the cognitive and motor development domains. Children with CZS presented a mean growth rate (head circumference and weight) lower than typical children. Therefore, children with CZS are at risk for growth retardation and development compared to typical children.

This study evaluated nutritional status linked to zinc levels in 239 randomly selected children at crèches in Teresina, Brazil, aged 3 to 6. Blood samples were collected after fasting of 10 h. Erythrocytary zinc levels were determined through flame atomic absorption spectrophotometry. Zinc deficiency was determined as below 40 microg Zn/g Hb. Infant linear growth was evaluated measuring weight and height, and nutritional status by height/age, weight/height, and weight/age indices, expressed as Z scores, in line with the National Center for Health Statistics. The mean zinc concentration was 35.50 +/- 10.95 microg Zn/g Hb. Zinc distribution in the 10, 50, 75, and 90 percentiles was 24.73 microg Zn/g Hb, 35.45 microg Zn/g Hb, 40.73 microg Zn/g Hb and 52.77 microg Zn/g Hb, respectively. Based on this distribution, normal values were found only from the 75th percentile and above. Since the cutoff point adopted was 40 microg Zn/g Hb, the prevalence of zinc deficiency was 74.3%. As for growth profile, 8.4% were chronically malnourished, although the statistical association between linear impairment and nutritional status regarding zinc was insignificant. The study revealed that an important segment of the infant population was mineral deficient; however, the degree of deficiency did not influence growth profiles.

The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) South American site was Pelotas, Brazil. The sample for the longitudinal component was drawn from three hospitals that account for approximately 90% of the city's deliveries. The cross-sectional sample was drawn from a community survey based on households that participated in the longitudinal sample. One of the criteria for site selection was the availability of a large, community based sample of children whose growth was unconstrained by socioeconomic conditions. Local work done in 1993 demonstrated that children of families with incomes at least six times the minimum wage had a stunting rate of 2.5%. Special public relations and implementation activities were designed to promote the acceptance of the study by the community and its successful completion. Among the major challenges of the site were serving as the MGRS pilot site, low baseline breastfeeding initiation and maintenance rates, and reluctance among pediatricians to acknowledge the relevance of current infant feeding recommendations to higher socioeconomic groups.

The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) is a community-based, multicountry project to develop new growth references for infants and young children. The design combines a longitudinal study from birth to 24 months with a cross-sectional study of children aged 18 to 71 months. The pooled sample from the six participating countries (Brazil, Ghana, India, Norway, Oman, and the United States) consists of about 8,500 children. The study subpopulations had socioeconomic conditions favorable to growth, and low mobility, with at least 20% of mothers following feeding recommendations and having access to breastfeeding support. The individual inclusion criteria were absence of health or environmental constraints on growth, adherence to MGRS feeding recommendations, absence of maternal smoking, single term birth, and absence of significant morbidity. In the longitudinal study, mothers and newborns were screened and enrolled at birth and visited at home 21 times: at weeks 1, 2, 4, and 6; monthly from 2 to 12 months; and every 2 months in their second year. In addition to the data collected on anthropometry and motor development, information was gathered on socioeconomic, demographic, and environmental characteristics, perinatal factors, morbidity, and feeding practices. The prescriptive approach taken is expected to provide a single international reference that represents the best description of physiological growth for all children under five years of age and to establish the breastfed infant as the normative model for growth and development.