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Pacifier use during childhood has been hypothesized to interfere with language processing, but, to date, there is limited evidence revealing detrimental effects of prolonged pacifier use on infant vocabulary learning. In the present study, parents of 12‐ and 24‐month‐old infants were recruited in Oslo (Norway). The sample included 1187 monolingual full‐term born (without visual, auditory, or cognitive impairments) infants: 452 (230 girls; 222 boys) 12‐month‐olds and 735 (345 girls; 390 boys) 24‐month‐olds. Parents filled out an online Norwegian Communicative Development Inventory (CDI), which assesses the vocabulary in comprehension and production for 12‐month‐old infants and in production only for 24‐month‐old infants. CDI scores were transformed into age‐ and sex‐adjusted percentiles using Norwegian norms. Additionally, parents retrospectively reported their child's daytime pacifier use, in hours, at 2‐month intervals, from birth to the assessment date. Maternal education was used to control, in the analyses, for the socio‐economic status. We found that greater pacifier use in an infant's lifespan was associated with lower vocabulary size. Pacifier use later in life was more negatively associated with vocabulary size than precocious use, and increased the odds of being a low language scorer. In sum, our study moves beyond the findings of momentary effects of experimentally induced "impairment" in articulators' movement on speech perception and suggests that, from 12 months of age, constraints on the infant's speech articulators (pacifier use) may be negatively associated with word comprehension and production. Research Highlight: We examined the relationship between pacifier use and vocabulary sizes in production at 24 months of age and comprehension and production at 12 months of age.Lifespan Pacifier Use (LPU) was negatively correlated with vocabulary sizes in comprehension and production among 12‐month‐old infants and negatively correlated with production for 24‐month‐olds.Later pacifier use was found to be more negatively correlated with vocabulary size in infants, as compared to more precocious use.The amount of pacifier use in the 2 months prior to a child's second birthday was predictive of a higher prevalence of low vocabulary scores in 24‐month‐olds. [ABSTRACT FROM AUTHOR]

Aims: The effect of nonnutritive sucking (NNS) stimulation is unclear in infants with perinatal asphyxia. Thus, the aim of this study was to assess the effect of NNS stimulation on oral intake, discharge time, and early feeding skills in infants with perinatal asphyxia. Design: A randomized controlled study was conducted. Method: Of the 94 infants, 47 were included in the experimental group and given NNS stimulation once a day before tube feeding by a speech-language therapist (SLT) in addition to hypothermia treatment. Infants' feeding performances on the days of first oral intake and discharge were evaluated with the Early Feeding Skills Scale (EFS). Results: The time from tube feeding to oral intake was significantly lower in the experimental group compared to the control group (p < .05). EFS scores at discharge were significantly higher in the experimental group than in the control group (p < .05). There was no significant difference between the experimental and control groups in terms of discharge and weight gain (p > .05). Conclusions: The findings indicated that the NNS stimulation positively affected oral intake and early feeding skills in infants with perinatal asphyxia, as in preterms. However, NNS stimulation had no significant effect on discharge and weight gain in infants with asphyxia. This finding may be attributed to other factors. It is recommended to use NNS by an SLT in a neonatal intensive care unit within a multidisciplinary team to accelerate the transition to oral feeding and improve feeding skills in infants with perinatal asphyxia. Further studies on the effect of NNS stimulation in infants with perinatal asphyxia are needed to corroborate its effects on discharge time and weight gain. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine associations between parent reports of bottle-feeding behaviors and infant non-nutritive suck (NNS) on a pacifier as well as oral feeding skills during bottle-feeding. A prospective study was conducted. Full-term infants with no prior diagnosed feeding disorders were recruited at 3-months. Parents reported their infant's bottle-feeding behaviors using the Neonatal Eating Assessment Tool-Bottle-Feeding (NeoEAT-Bottle-Feeding), consisting of five domains: Infant Regulation, Energy and Physiologic Stability, Gastrointestinal Tract Function, Sensory Responsiveness, and Compelling Symptoms of Problematic Feeding. Infant NNS was measured using a custom pacifier, pressure transducer device, which yields the following NNS variables: duration (sec), frequency (Hz), amplitude (cmH20), cycles per burst, cycle amount, and burst amount. The Oral Feeding Skills (OFS) scale was used to measure the initial volume, transfer volume, proficiency, and rate of milk transfer during bottle feeding. Fifty-two infants (58% male) with reported prior bottle experience completed this study. NeoEAT-Bottle-Feeding Total score was significantly positively associated with NNS burst duration and NNS cycles per burst. The NeoEAT-Bottle-Feeding Energy and Physiologic Stability domain was significantly positively correlated with NNS cycles per burst. NeoEAT-Bottle-Feeding Gastrointestinal Tract Function domain score was significantly positively correlated with NNS duration, amplitude, and cycles per burst. There were no significant associations between NeoEAT-Bottle-Feeding domains and the OFS scale. The findings demonstrate that parent reports of problematic feeding at 3 months of age are associated with aspects of infant NNS physiology and not with oral feeding metrics during bottle-feeding. Parent reports of bottle-feeding behaviors, particularly pertaining to gastrointestinal issues, were associated with aspects of infant NNS. These data together will allow for a more nuanced understanding of infant feeding and will be beneficial in determining if infants have a feeding delay. [ABSTRACT FROM AUTHOR]

The majority of infants with congenital talipes equinovarus (CTEV) require tenotomy of the tendoachilles. The pain response of this procedure in the awake infant has not been previously reported. In this observational study, multimodal pain management strategies, including oral sucrose, oral paracetamol, topical anesthetic, local anesthetic, a pacifier (dummy), and swaddling, were used. Physiological responses and pain were recorded. Pain was rated out of 10 at regular intervals, using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale. Ninety-one infants (65 men, mean age = 53 days, range = 19-217 days) were observed. At baseline, median FLACC, heart rate (HR), and oxygen saturation (Sp o 2) were 1, 159, and 97% respectively. Peak median FLACC and HR were 9 and 200, respectively, and lowest median Sp o 2 was 92%. The median (interquartile range) time for FLACC to return to 3 or less was 2 (2-5) minutes. Achilles tenotomy for CTEV in the awake infant is associated with high pain levels despite provision of multimodal pain relief measures. [ABSTRACT FROM AUTHOR]

Introduction: Evidence of opioid use at hospital delivery has increased over the past two decades, increasing risk of neonatal withdrawal. Breastfeeding may improve infant outcomes, but little is known about breastfeeding experiences of women who have a history of opioid use prior to or during pregnancy. This study aimed to determine if self-reported opioid use prior to or during pregnancy impacted breastfeeding, specifically attempt to breastfeed, duration of breastfeeding, assessment of prenatal breastfeeding intention, source of breastfeeding information, and early hospital experiences. Methods: Data from ten states (n = 10,550) that evaluated opioid use in the 2016 Pregnancy Risk Assessment Monitoring System survey were included. Weighted univariate and multivariate linear and logistic regression were calculated. The multivariate regression also included adjustment for covariates. Results: Among the overall sample, 939 participants reported opioid exposure before or during pregnancy. We found no significant difference in breastfeeding attempt. Breastfeeding for at least 6, 10, or 20 weeks was significantly less likely in participants reporting opioid exposure. Exposure correlated with lower odds of skin-to-skin contact, infant being fed in the first hour, exclusive breastfeeding in the hospital, and feeding on demand. Hospital pacifier use was associated with opioid exposure. Conclusion: While we found no difference in breastfeeding attempt, we did observe significant differences in breastfeeding duration and early hospital experiences which may represent modifiable gaps in clinical practice. Future work should focus on optimizing early hospital experiences and support when breastfeeding is clinically indicated. [ABSTRACT FROM AUTHOR]

The purpose of this study is to assess whether pacifier use is associated with breastfeeding success in term and preterm newborns and whether it influences hospitalization time in preterm newborns. Four databases were searched for randomized controlled trials (RCTs), and a systematic review and meta-analysis were conducted. The risk of bias and evidence quality, according to the GRADE methodology, were analyzed. Risk ratios with 95% confidence intervals (CI) for dichotomous outcomes and mean difference (MD) for continuous outcomes were used. The random effect model was used if heterogeneity was high (I2 over 40%). We screened 772 abstracts, assessed 44 full texts, and included 10 studies, of which 5 focused on term and 5 on preterm newborns. There were a few concerns about the risk of bias in 9 of the 10 studies. Breastfeeding rates were analyzed at 2, 3, 4, and 6 months, and the success rates were similar between the restricted and free pacifier use groups (evidence quality was moderate to high). In preterm neonates, the use of a pacifier shortened the duration of hospitalization by 7 days (MD 7.23, CI 3.98-10.48) and the time from gavage to total oral feeding by more than 3 days (MD 3.21 days, CI 1.19-5.24) (evidence quality was ranked as moderate).   Conclusions: Based on our meta-analysis, pacifier use should not be restricted in term newborns, as it is not associated with lower breastfeeding success rates. Furthermore, introducing pacifiers to preterm newborns should be considered, as it seems to shorten the time to discharge as well as the transition time from gavage to total oral feeding. What is Known: • Observational studies show that infants who use a pacifier are weaned from breastfeeding earlier. • Previous randomized studies have not presented such results, and there have been no differences in the successful breastfeeding rates regardless of the use of pacifier. What is New: • Term and preterm newborns do not have worse breastfeeding outcomes if a pacifier is introduced to them, and additionally preterm newborns have shorter hospitalization times. • The decision to offer a pacifier should depend on the caregivers instead of hospital policy or staff recommendation, as there is no evidence to support the prohibition or restriction. [ABSTRACT FROM AUTHOR]

Aim: This study was conducted to examine the effect of three different methods for reducing pain and stress among term neonates undergoing venipuncture. Materials and Methods: The research sample comprised 80 term neonates with hyperbilirubinemia who were being treated at the Neonatal Intensive Care Unit. The term neonates were allocated, according to the randomization method, into a smelling breast milk group (n=20), a pacifier/dummy group (n=20), a prone position group (n=20), and a control group (n=20). Results: It was determined that there was a statistically significant correlation between the pain and stress score averages of the breast milk, prone position, and pacifier/dummy groups according to all measurements taken before, during, and after the procedure (p<0.001). It was discovered that there was a difference between the Premature Infant Pain Profile-Revised form (PIPP-R) and the mean stress scores of the control group and the breast milk, prone position, and pacifier/dummy groups after the procedure (p<0.001). Conclusion: In study, it was concluded that the breast milk smell, prone position, and giving a pacifier made of sterile gloves are effective in reducing the pain and stress of newborns during the venipuncture procedure. Non-pharmacological methods such as smelling breast milk, prone position, and giving a pacifier/dummy are recommended to reduce pain and stress among term neonates during interventional procedures. [ABSTRACT FROM AUTHOR]

Introduction: Food inadequacies in the first 6 months of life are considered a global problem, with an emphasis on early complementary feeding introduction (CFI). This study aimed to identify the determinants of CFI. Methods: A birth cohort study (N = 641). Data on infant feeding was collected before 30 days, and at 2, 4, and 6 months of age and, at baseline, data regarding socioeconomic status, demographics, maternal and infant health, obstetric history, and infant care. The hypothesis was that the risk determinants for early CFI vary according to the type of food and the age range of this introduction. Twelve Cox regression models were fit with four outcomes (formula; other types of milk; other beverages; and solid/semi-solid foods) considering three different age ranges of the infant at their introduction (< 2 months, 2–4 months, and 4–6 months). Results: The introduction of the four food groups analyzed was early (median ages of introduction: formulas = 45 days; other milks = 135 days; other beverages = 120 days; solids and semi-solids = 135 days). The determinants that increased the risk of introducing formulas before 2 months were: primiparity, employed without maternity leave, mothers with unsatisfactory prenatal counseling and those who had cesarean sections. Not living with a partner, infant pacifier use at 2 months of age had a higher risk of introducing formula between 2 and 4 months of age. Non-white skin color, more than 35 years old, low maternal education, and lower family income increased the risk of introducing other types of milk between 2 and 4 months of age. Between 4 and 6 months of age, adolescent and low education level mothers had a higher risk of introducing other types of milk, unemployed was a protective factor against the introduction of other foods and beverages in this age group. Conclusions: The determinants of early CFI varied according to the type of food and the age of introduction. [ABSTRACT FROM AUTHOR]

Objective: Breastfeeding is the principal feeding source in the first years of life. Its targeted rates are not achieved properly, globally. Multifactorial reasons have been reported, but the effect of the facilities in the hospitals including lactation consultation clinics have rarely been discussed. The aim of this study was to assess the effects of breastfeeding education in a first officially organized clinic. This may further help authorities make any necessary interferences and improve public health strategies. Materials and Methods: A cross-sectional, interventional study was performed in 100 mothers who were given breastfeeding education and was compared with 100 mothers without education. All of the mothers were interviewed to assess breastfeeding attitudes after 6 months. Results: The study group demonstrated higher exclusive breastfeeding rates than controls (76% and 28%, respectively). Having an education was the most significant factor affecting exclusive breastfeeding duration (P< .05). Complementary feeding, bottles, and pacifiers were introduced significantly earlier in the control group (P < .05) There was a negative association between breastfeeding duration and both bottle and pacifier use (P < .05). Conclusion: Lactation consultation at a breastfeeding clinic improved the breastfeeding rate. Extending this project to maternity and children's hospitals will help to achieve the desired national targets in exclusive breastfeeding. [ABSTRACT FROM AUTHOR]

With the filing of a class action lawsuit claiming NUK Orthodontic Pacifiers harm oral development in children older than 24 months, it is now more important than ever to assure that recommendations for pacifier use are based in science. Often overlooked is the importance of proper size selection and design characteristics of the bulb and shield of the pacifier itself. Pacifier companies are now being asked for validation of the packaging claims made to the consumer in an age where quantifiable biometric parameters can be analyzed with technologies that are readily available. The use of a free smart phone application (app) currently in development can guide parents when selecting the right size pacifier for their baby. This article reviews the science behind pacifier use, ergonomics, facial anthropometrics, physical parameters of the infant, and the use of biometrics in pacifier selection. It enforces the importance for all stakeholders to understand how the development of the face and jaws are affected by non-nutritive sucking with a pacifier. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the association of oral parafunctions with the presence of signs and symptoms of craniomandibular disorder in children with cleft lip and palate (CLP). A cross-sectional study was performed in which one hundred and eighty-eight children with CLP and absence of associated syndromes or malformations were investigated. During clinical examination, the presence of wear facets and dental occlusion were observed and palpation was performed in the temporomandibular joint region (TMJ) and orofacial musculature. The children and their guardians were interviewed regarding the presence of oral parafunctional habits (bruxism, the act of biting the lips and/or cheeks, nail biting, sucking of fingers and pacifiers) and signs and symptoms of craniomandibular dysfunction (headache, ear and/or neckache, tiredness or crack in the TMJ during mouth opening and chewing movements). The data were analyzed by means of absolute and relative frequency measurements, and bivariate analysis using Pearson's chi-square test and likelihood ratio test were performed, considering the significance level of 5%. A higher prevalence of cleft lip and palate type (76.0%) and the presence of malocclusion (61.7%) was observed, highlighting the anterior crossbite (58.7%) and midline deviation (48.9%). There was a higher occurrence of teeth grinding (40.4%), onychophagy (28.7%) and biting lips and/or cheeks (28.7%). Onychophagia was associated with headache (p <0.05) and with pain or cracking during mouth opening (p <0.05). It was concluded that parafunctional oral habits may be associated with signs and symptoms of craniomandibular disorder in children with cleft lip and palate. [ABSTRACT FROM AUTHOR]

We investigate when infants exhibit knowledge of the familiar size of well‐known objects and whether this knowledge is affected by stimulus format, that is, whether the stimuli are presented as real objects or matched pictures. Infants (130 7‐ and 12‐month‐olds) saw everyday objects such as sippy cups and pacifiers in their familiar size and novel sizes (larger or smaller than the familiar size) placed pairwise within infants' reach. We used a preferential‐looking paradigm to investigate whether infants are able to discriminate familiar from novel sizes. Although, infants of both age groups looked longer toward real objects that were smaller or larger than the familiar size, there were no looking preferences for the pictures. These results suggest that although 7‐ and 12‐month‐olds demonstrate familiar size knowledge for real objects, this understanding does not generalize to pictorial representations of those objects. [ABSTRACT FROM AUTHOR]

Background: The current literature suggests a link between dummy (or pacifier) use and a number of both positive and detrimental consequences. Positive consequences include soothing effect and protection from sudden infant death syndrome (SIDS), while negative ones include increased risk of otitis media and dental malformation. However, there is little research surrounding the impact of dummy use on the development of speech sounds. Aims: To investigate whether duration (in number of months) and frequency per day of dummy use have an individual or combined effect on the development of a child's speech, and if so, in what way. Methods & Procedures: A total of 100 British‐English children aged 24–61 months and growing up in the UK were recruited through nurseries, playgroups and by word of mouth. Their parents were asked to complete a questionnaire about the duration and frequency of dummy use and factors known to influence the development of speech. Following this, the children's speech was assessed using the phonology section of the Diagnostic Evaluation of Articulation and Phonology (DEAP). Analysis of the DEAP was conducted to determine the percentage of consonants correct, number of age‐appropriate, delayed and atypical errors. Dummy use and speech outcome measures were then analysed qualitatively and quantitatively using mean and median group comparisons alongside multivariate generalized least squares and generalized negative binomial modelling approaches to test for significant associations. Outcomes & Results: The results showed that the majority of speech outcomes are not significantly associated with dummy use, however measured, in bivariate or multivariate analyses. However, there is a significant association between increased atypical errors and greater frequency of daytime dummy use. This association is strengthened by restricted sampling within the younger members of the sample, with this association not observable within children older than 38 months, the median sample age. Conclusions & Implications: The evidence base for any effects of dummy use on speech is very small. Dummy use may increase the number of atypical speech errors a young child makes. However, only the frequency of daytime use seems relevant, not the duration or night‐time use, and these errors may resolve over time. What this paper addsWhat is already known on this subjectThe use of a dummy with infants in Western countries is comparatively high (between 36‐85%). A number of positive and detrimental consequences of dummy use have been documented in the literature; however, research on the effect of dummy use on speech development is significantly lacking. Past studies have included small sample sizes or used single measures of speech outcomes, which may not be specific enough to reveal how speech may be affected. Many speech and language therapists speculate that the use of a dummy could be contributing to many of the conditions they treat, yet this claim remains largely unsubstantiated.Clinical implications of this studyThe study suggests that only prolonged use of a dummy over several hours and during the day may start to show any impact on speech; even then, professionals need to be aware that the evidence base for any speech effects is very small. Clinicians and other professionals who parents consult on dummy use should make sure to provide both the pros and cons of dummy use, in order to enable parents to make an informed decision. [ABSTRACT FROM AUTHOR]

Background: The association between prolonged non‐nutritive sucking habits (NNSHs, ie, sucking pacifiers or fingers) and maxillofacial growth anomalies in the general population has been widely described. Because maturation of sucking abilities is not fully achieved in very preterm infants (<32 weeks' gestation), neonatal services worldwide rely on the use of pacifiers to promote the development of adequate sucking reflexes, possibly prolonging NNSHs during infancy. Objective: We aimed to describe the frequency and to identify factors associated with NNSHs at age 2 years in very preterm children. Methods: The study was based on data from EPIPAGE‐2, a French national prospective cohort study of preterm births during 2011 that included 2593 children born between 24 and 31 weeks' gestation. The primary outcome was NNSHs at 2 years. Multivariable log‐linear regression models with generalized estimation equations were used to study the association between the characteristics studied and NNSHs. Multiple imputations were used to take into account missing data. Results: The frequency of NNSHs was 69% in the overall sample but higher among girls (adjusted risk ratio [RR] 1.12, 95% confidence interval [CI] 1.05, 1.17), children born from multiple pregnancies (eg, twins/triplets) (RR 1.07, 95% CI 1.00, 1.11), children who were fed by nasogastric tube (RR 1.07, 95% CI 1.01, 1.13), or those who benefitted from developmental care programmes (RR 1.10, 95% CI 1.02, 1.19). The NNSHs frequency was lower if mothers were not born in France (RR 0.70, 95% CI 0.64, 0.77), children had 2 or more older siblings (RR 0.88, 95% CI 0.82, 0.96), or children were breast‐fed at discharge (RR 0.90, 95% CI 0.85, 0.95). Conclusions: NNSHs at 2 years seemed associated with cultural background, development care programmes, and breast feeding. Whether NNSHs at 2 years among very preterm children are associated with future maxillofacial growth anomalies deserves further attention. [ABSTRACT FROM AUTHOR]

Introduction: Introduction and objectives: breastfeeding (BF) is a feeding method that provides multiple benefits for the health of infants and their mothers. This study aimed to determine the prevalence of BF during the first year of life of children of women who gave birth in a private clinic in Biscay, Basque Country, Spain, and to identify the facilitating determinants and reasons for abandonment. Method: an observational, descriptive, longitudinal and prospective study in a random sample of 453 newborns (NBs) recruited between 2016 and 2017. Results: in all, 366 women agreed to participate in all the study phases. The prevalence of exclusive breastfeeding (EBF) was 51.7 % at baseline, 77.1 % at discharge, and 21.6 % after sixth months; and that of BF, 87.1 % at the beginning, 48.4 % at month six, and 20.6 % at one year. The facilitating factors of EBF were: at the beginning, not using a nest or breast pump; 15 days of satisfaction with LM and not using a pacifier or breast pump; 4 months of satisfaction with LM; 6 months attending Lactation Support Groups (GAL) and not introducing complementary feeding (CA); and those of LM at 1 year, attending GAL. The main reasons for abandonment were: own initiative, incorporation to work, and little weight gain by the NB. Conclusions: one in 5 newborns received EBF up to 6 months and BF up to one year. It would be necessary to promote strategies that favor breastfeeding, such as eliminating the nest, advising against breast pumps and pacifiers at the beginning, starting CA from the sixth month, and organizing GALs during the first year. [ABSTRACT FROM AUTHOR]

BACKGROUND: Exogenous surfactants to treat respiratory distress syndrome (RDS) are approved for tracheal instillation only; this requires intubation, often followed by positive pressure ventilation to promote distribution. Aerosol delivery offers a safer alternative, but clinical studies have had mixed results. We hypothesized that efficient aerosolization of a surfactant with low viscosity, early in the course of RDS, could reduce the need for intubation and instillation of liquid surfactant. METHODS: A prospective, multicenter, randomized, unblinded comparison trial of aerosolized calfactant (Infasurf) in newborns with signs of RDS that required noninvasive respiratory support. Calfactant was aerosolized by using a Solarys nebulizer modified with a pacifier adapter; 6 mL/kg (210 mg phospholipid/kg body weight) were delivered directly into the mouth. Infants in the aerosol group received up to 3 treatments, at least 4 hours apart. Infants in the control group received usual care, determined by providers. Infants were intubated and given instilled surfactant for persistent or worsening respiratory distress, at their providers' discretion. RESULTS: Among 22 NICUs, 457 infants were enrolled; gestation 23 to 41 (median 33) weeks and birth weight 595 to 4802 (median 1960) grams. In total, 230 infants were randomly assigned to aerosol; 225 received 334 treatments, starting at a median of 5 hours. The rates of intubation for surfactant instillation were 26% in the aerosol group and 50% in the usual care group (P < .0001). Respiratory outcomes up to 28 days of age were no different. CONCLUSIONS: In newborns with early, mild to moderate respiratory distress, aerosolized calfactant at a dose of 210 mg phospholipid/kg body weight reduced intubation and surfactant instillation by nearly one-half. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the effects of maternal breastfeeding, artificial feeding, types of introduction of complementary food introduction and the use of bottle and pacifier on lip/tongue pressure and maximum molar bite force of school children. Thirty-five healthy children with mixed dentition (20 boys and 15 girls), aged 6-10 years, participated in this study. The children were evaluated based on anthropometry, electronic scale and portable stadiometer, feeding practices (breastfeeding, artificial feeding, introduction of complementary food), bottle and pacifier use, tongue and lips strength and molar bite force. The results were submitted to ANOVA (p <.05). The sample showed a predominance of children with adequate height and weight for age. In the analysis of the influence of the food introduction period, the complementary food consistency and the pacifier use; it was observed that these factors did not influence the pressures of the lips/tongue statistically. In the evaluation of the influence of bottle feeding, the data showed higher bite force for children who never used the bottle, statistically significant data for the right and left sides (p = .003 and p = .001, respectively). The authors suggest that the type of breastfeeding received by the children may have a negative impact on the stomatognathic system functioning, evidenced by the lower maximum molar bite force found in the bottle-fed children. [ABSTRACT FROM AUTHOR]

Purpose: Even routine procedures can cause pain and stress, and can be harmful to the fast‐growing brain of preterm infants. Mitigating pain and stress with sucrose and analgesics has side effects; thus, an alternate choice is the use of natural breast milk and infants' sensory capabilities. Therefore, this study examined the effects of different integrations of sensory experiences—mother's breast milk odor and taste (BM‐OT), heartbeat sounds (HBs), and non‐nutritive sucking (NNS)—on preterm infant's behavioral stress during venipuncture. Design: This study was a prospective, randomized controlled trial. Methods: Infants born preterm (<37 weeks' gestational age) were enrolled in the study through convenience sampling, and randomly assigned to the following conditions: (condition 1) routine care (n = 36); (condition 2) BM‐OT (n = 33); (condition 3) BM‐OT + HBs (n = 33); or (condition 4) BM‐OT + HBs + NNS (n = 36). Crying duration from puncture to recovery period was recorded using a voice recorder. Facial actions and body movements were measured using an infant behavioral coding scheme and transformed into frequencies during seven stages: baseline (stage 0), disinfecting (stage 1), venipuncture (stage 2), and the recovery period for 10 minutes (stages 3–6). Findings: Data were analyzed for 138 preterm infants. The corresponding median times to stop crying for conditions 1, 2, 3, and 4 were 137, 79, 81, and 39 s, respectively; the instantaneous occurrence rates of stopping crying for conditions 2, 3, and 4 were 1.469, 1.574, and 2.996 times greater than for condition 1, respectively. Infants receiving conditions 3 and 4 had significantly fewer occurrences of facial actions (stage 6 and stages 4–6, respectively) and body movements (stages 3–6 for both); however, there were no significant reductions in stress behaviors for condition 2 (BM‐OT). Conclusions: The combination of BM‐OT, HBs, and NNS could be provided to preterm infants as interventions to prevent and reduce behavioral stress, and facilitate pain recovery during venipuncture procedures. Clinical Relevance: Clinicians should be educated about how to recognize preterm infants' behavioral stress, and to incorporate different sensory combinations of respective mothers' BM, HBs, and NNS into painful procedures to help preterm infants recover from distress. [ABSTRACT FROM AUTHOR]

Objective: Infant sleep plays a critical role in normal development. Sleep problems, including sleep onset difficulties (SODs) and night waking (NW), range from 20% to 30% in infants and young children and can be persistent over time up to adulthood. Young French children seem to have longer sleep durations and less sleep troubles than their counterparts worldwide. Here, we aimed at describing infant sleep characteristics (total sleep time (TST)/24 h, NW, and SODs) and associated sleep habits in infants at age one year from the French nationwide birth cohort Etude Longitudinale Française depuis l'Enfance (ELFE).Methods: This study included 11,783 infants with information on both sleep characteristics and sleep habits (parental presence when falling asleep, eating to fall asleep, sucking a pacifier or finger to sleep and sleep arrangement and location). Associations were studied by multinomial logistic regression analyses adjusted for familial and infant characteristics.Results: Mean TST was 13 h36 min including 2 h54 min of naps; 20% of the infants had TST ≤12 h/24 h. About 46% did not present SOD or NW, 16% had frequent SODs and 22% had NW > 1 night in 2. Parental presence, feeding to fall asleep and infant sleep arrangements were frequent in infants with short sleep duration (≤12 h/24 h), NW and SODs. Non-nutritive sucking was associated with risk of NW, SOD and TST >14 h/24 h. Parental room sharing was associated with NW.Conclusion: This work provides new information on infant sleep arrangements and non-nutritive sucking that should be accounted for when considering sleep behaviors. In addition, most identified sleep habits associated with poor sleep characteristics may be amenable to change. [ABSTRACT FROM AUTHOR]

Twenty years of research demonstrate that multiple positive benefits accrue from Neonatal Intensive Care-Music Therapy (NICU-MT), an evidence-based, specialized training in music therapy, neurodevelopmental, family care intervention for premature infants. Research is now advanced enough to identify specific, detailed NICU-MT protocols, type of music, and expected outcomes appropriate for gestational age, neurodevelopmental responses, and sex of the infant. This article reviews the research in this area and describes 11 referral reasons and NICU-MT protocols for premature infants and four reasons for counseling/interaction training with their parents. Additionally, three protocols are described for following premature infants after discharge to assist parents with transition to home care. Because NICU-MTs are often requested to assist with treatment of the epidemic of inconsolable infants with neonatal abstinence syndrome (NAS), a research review for this treatment area and four evidence-based NICU-MT protocols to console and facilitate NICU treatment of NAS infants is also included. [ABSTRACT FROM AUTHOR]

Introduction: Breastfeeding is essential for the proper growth and development of children due to its energy and nutritional composition, immunological factors, and safety from a hygienic and health perspective. Objective: In light of this, this study aimed to assess the maternal sociodemographic factors associated with exclusive breastfeeding. Materials and Methods: A cross-sectional study was conducted with 143 pairs of mother-child less 24 months of age that were assisted in four Primary Healthcare Centers in São Luís (MA). The first form was used to collect socioeconomic and demographic data from mother-child pairs. The second form was answered by 75 mothers with early cessation of exclusive breastfeeding. The duration of exclusive breastfeeding, antenatal and postpartum care for women, social support in breastfeeding and the influence of the use of pacifiers and bottles on the cessation of exclusive breastfeeding were assessed. Fisher's Exact Test was used to check the association between the variables. Results: It was observed that 33.3% of children had exclusive breastfeeding for the first six months and that breastfeeding time was longer (93.3%) among those children who benefited from social programs. Discussion and Conclusions: The low frequency of exclusive breastfeeding time in children revealed the need to develop strategies to encourage breastfeeding in primary healthcare so that it can contribute to the qualification of nutritional and prenatal care. [ABSTRACT FROM AUTHOR]

The article focuses on the use of nonnutritive sucking habits, especially pacifiers with the purpose of calming children, favoring their sleep, and providing them their physiological and psychological needs. It mentions that Candida albicans was able grow and adhere on the silicone surface of the pacifiers even in the absence of nutrient culture medium.

Studies suggest that when children do not achieve the emotional satiety and adequate stimulus provided by breast-feeding, they exhibit sucking behaviors. This study aimed to estimate the association from 4 through 6 months of exclusive breast-feeding (EB) postpartum and pacifier-sucking behavior at 12 months of life. A cohort study was conducted with 1,037 infants, born alive and monitored up to 12 months. At 4 and 6 months after birth, the children were classified according to the type of breast-feeding they had received: exclusive, predominant, complementary, or none. The prevalence of pacifier-sucking behavior was calculated, and the association between the 2 events was estimated. Mothers' socioeconomic-demographic characteristics, delivery features, and prenatal care, as well as the biological characteristics of the children, were determined. Relative risk (RR) and 95% confidence intervals (95% CI) were calculated. In comparison with EB infants, the RR of pacifier-sucking behavior at 12 months of life was higher in children receiving complementary breast-feeding or no breast-feeding for both 4 months (RR adjusted , 1.68 [95% CI, 1.39 to 2.02] and RR adjusted , 2.67 [95% CI, 2.24 to 3.17], respectively) and 6 months (RR adjusted , 1.43 [95% CI, 1.03 to 2.00] and RR adjusted , 3.30 [95% CI, 2.40 to 4.54], respectively). EB for 6 months postpartum is associated with reduced pacifier-sucking behavior, adjusted for maternal color, number of prenatal consultations, and family income. Promotion of EB may reduce the use of pacifiers and their potential deleterious effects on oral health. Dental health care professionals should consider discussing the importance of breast-feeding with their patients with regard to the possible development of sucking habits in their children. [ABSTRACT FROM AUTHOR]

Background/Aims: This pilot study aimed to evaluate the occurrence of oral habits and non-nutritive sucking habits in children with cleft (lip and) palate (CL/P) between 0–12 years, compared to peers without CL/P. Methods: Children with CL/P (mean age 6.0 years, SD 2.80) were recruited from the Ghent University Hospital and compared to gender- and age-matched children without CL/P (mean age 5.8 years, SD 3.09). A self-report questionnaire was developed and given to the caregivers. To compare the occurrence of oral habits and non-nutritive sucking habits in children with and without CL/P, χ2 tests or Fisher's exact tests were used. Results: The present study revealed a significantly lower occurrence of non-nutritive sucking habits in children with CL/P. These children showed significantly less pacifier sucking; no significant difference was found regarding thumb or finger sucking nor regarding sucking on other objects. Additionally, the results showed that the occurrence of snoring was statistically significantly higher in children with CL/P. Conclusion: Children with CL/P show less non-nutritive sucking habits, but more snoring compared to a control group without CL/P. Although further research regarding the oral habits in children with CL/P is necessary, cleft teams should give attention to the occurrence of oral habits. [ABSTRACT FROM AUTHOR]

Background: Non-nutritive suck (NNS) is used to promote ororhythmic patterning and assess oral feeding readiness in preterm infants in the neonatal intensive care unit (NICU). While time domain measures of NNS are available in real time at cribside, our understanding of suck pattern generation in the frequency domain is limited. The aim of this study is to model the development of NNS in the frequency domain using Fourier and machine learning (ML) techniques in extremely preterm infants (EPIs). Methods: A total of 117 EPIs were randomized to a pulsed or sham orocutaneous intervention during tube feedings 3 times/day for 4 weeks, beginning at 30 weeks post-menstrual age (PMA). Infants were assessed 3 times/ week for NNS dynamics until they attained 100% oral feeding or NICU discharge. Digitized NNS signals were processed in the frequency domain using two transforms, including the Welch power spectral density (PSD) method, and the Yule-Walker PSD method. Data analysis proceeded in two stages. Stage 1: ML longitudinal cluster analysis was conducted to identify groups (classes) of infants, each showing a unique pattern of change in Welch and Yule-Walker calculations during the interventions. Stage 2: linear mixed modeling (LMM) was performed for the Welch and Yule-Walker dependent variables to examine the effects of gestationally-aged (GA), PMA, sex (male, female), patient type [respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD)], treatment (NTrainer, Sham), intervention phase [1, 2, 3], cluster class, and phase-by-class interaction. Results: ML of Welch PSD method and YuleWalker PSD method measures revealed three membership classes of NNS growth patterns. The dependent measures peak_Hz, PSD amplitude, and area under the curve (AUC) are highly dependent on PMA, but show little relation to respiratory status (RDS, BPD) or somatosensory intervention. Thus, neural regulation of NNS in the frequency domain is significantly different for each identified cluster (classes A, B, C) during this developmental period. Conclusions: Efforts to increase our knowledge of the evolution of the suck central pattern generator (sCPG) in preterm infants, including NNS rhythmogenesis will help us better understand the observed phenotypes of NNS production in both the frequency and time domains. Knowledge of those features of the NNS which are relatively invariant vs. other features which are modifiable by experience will likewise inform more effective treatment strategies in this fragile population. [ABSTRACT FROM AUTHOR]

With opioid use in North America rising, there is a growing incidence of neonatal abstinence syndrome (NAS). Infants with NAS experience withdrawal signs that interfere with their occupational performance in activities of daily living. This scoping review aims to identify the non-pharmacologic interventions currently used in the treatment of infants with NAS that fall within the scope of the occupational therapy profession. Searching three databases, articles were independently reviewed by two authors to meet defined inclusion criteria. Forty-five articles were included, and the interventions identified and organized according to the Person-Environment-Occupation Model. The non-pharmacologic interventions identified fall within the scope of the occupational therapy profession. Initiating occupational therapy services in an acute care setting may have the potential to improve occupational performance and engagement for these infants from an early age. [ABSTRACT FROM AUTHOR]

Despite significant reductions in incidence since the introduction of safe infant sleeping recommendations, sudden infant death syndrome is still the major cause of neonatal death in western countries. In the United States, over 2500 infants die suddenly and unexpectedly each year with nearly 100 deaths annually in Australia. Health professionals play a critical role in advising parents how to sleep their infants safely to minimise the risk of sudden infant death syndrome and sleeping accidents. Infants should be placed supine to sleep in a cot with a firm well‐fitting mattress in the parental bedroom with no soft or loose bedding which could obstruct the airway. Exposure to smoking both before and after birth should be minimised. Breastfeeding should be encouraged, as should immunisation. Dummies can be recommended after breastfeeding has been established. This review outlines the evidence behind these recommendations. [ABSTRACT FROM AUTHOR]

Background: Identifying key interventions to increase exclusive breastfeeding duration has been a challenge. Pacifier use has been associated with exclusive breastfeeding discontinuation in Brazil. However, the proportion of the improvement in exclusive breastfeeding duration attributable to pacifier use remains unknown. Research aim: Quantify the proportion of increases in exclusive breastfeeding prevalence that can be attributed to reduced pacifier use over time. Methods: Secondary data analyses of two nationally representative cross-sectional surveys conducted in States’ capitals in 1999 and in 2008 (N = 42,395 Brazilian infants under 6 months of age). We estimated the fraction of exclusive breastfeeding prevalence improvements that could be attributed to pacifier use based on multilevel regression analysis. Results: From 1999 to 2008, there was an increase of 15.2 percentage points in exclusive breastfeeding prevalence and a decrease of approximately 17 percentage points in the prevalence of pacifier use among infants under 6 months. Reduction in pacifier use explained an increase in 5.5 percentage points’ exclusive breastfeeding rates. If pacifier use were to decrease from 41.6% (prevalence in 2008) to 14% (as found in New Zealand), there would be an expected additional increase in exclusive breastfeeding of approximately 12 percentage points. Conclusions: About one-third of the improvements in EBF prevalence observed in Brazil over a decade can be attributed to the corresponding decline in pacifier use. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to describe the nutritive and non-nutritive oral sucking habits (breastfeeding, bottle use, pacifier/dummy/soother use, thumb/finger sucking) of preschoolers with and without phonological impairment, and to determine whether oral sucking habits are associated with the presence and severity of phonological impairment. Methods: We conducted a cross-sectional study of 199 Australian English-speaking preschoolers with and without phonological impairment. Preschoolers' speech was directly assessed, and parents/caregivers completed a questionnaire. Chi-square (χ2) tests were used to examine relationships between oral sucking habits and the presence and severity of phonological impairment. Results: Based on caregiver reports, 79.9% of participants had been breastfed (33.3% for >12 months), 58.3% had used a pacifier (74.2% for ≥12 months), 83.9% had used a bottle (73.4% for > 12 months), and 15.1% sucked their thumb/fingers. There was no association between a history of oral sucking and the presence and severity of phonological impairment. Conclusion: The majority of preschoolers had been breastfed and bottle-fed, and more than half had used a pacifier. The findings support an understanding that phonological impairment is not associated with a history of nutritive and non-nutritive sucking habits. Research is needed to examine the association between oral sucking habits and other types of speech sound disorders. [ABSTRACT FROM AUTHOR]

To determine the breastfeeding problems encountered in the postpartum period and effect of interventions done in relation to the problems based on breastfeeding studies in Turkey. This study is a systematic review and was conducted by performing a scan of the Turkish and English literature over the period October 2016-February 2017. The study included 27 articles and seven theses, which were published in 2000-2015 in Turkey and published in 2008-2017. Data are presented tabulating and the aggregate percentages were calculated for some data showing common characteristics. A total of 6736 parents and 592 babies were included in these studies. As a result of the combined percentage calculation based on the data of cross-sectional and case-control studies, the most frequently reported problems were having breastfeeding problem (24.5%), mother's milk deficiency/worry about milk deficiency/thinking her baby is not satisfied/baby's inadequate weight gain (15.7%), lack of knowledge and experience about breastfeeding/need for education and support (17.8%). Again, these studies showed that women stated the problems about have flat/depressed/small nipple (7.7%), pain/sensitivity (3.9%), swelling/fullness/ engorgement (10.8%), redness (28.8%), crack/wound/ bleeding (26.1%) and mastitis (5.6%). Methods of prenatal education/ counselling/motivation/follow-up, strong motivation, proactive lactation management and social support, moist warm application, using of breast milk and olive oil and using of breast shield and feeding with container and pacifier using have been reported to be effective in the experimental/quasi-experimental and case report studies included in this systematic review. This study showed that women experienced a lot problem with breastfeeding and that more prenatal education/counselling/monitoring was used in reducing problems. [ABSTRACT FROM AUTHOR]

Despite the advances and advantages of breastfeeding, the non-nutritive sucking habit, especially that represented by the use of pacifiers, is still common in Brazilian children. It is estimated that two thirds of children will receive bottles and pacifiers at some point in the first year of life. The frequency of use and the possibility of contamination by harmful microorganisms may lead to the development of opportunistic infections affecting the children's health. The objective of the study was to conduct a microbiological and structural analysis of pacifiers for children treated in public services and daycare centers. A cross-sectional study was carried out with pacifiers for children aged 6 to 36 months. The collected pacifier was placed in a sterile individualized container and transferred to the laboratory for analysis. The children's pacifiers who are cared for in public health services and day care centers are contaminated not only the dirty ones but also the visually clean ones. The potentially pathogenic microorganisms found were mainly fungi and bacteria, Candida, Streptococcus and Pseudomonas, respectively. [ABSTRACT FROM AUTHOR]

Non-nutritive sucking is often used with premature infants by either using a pacifier or an expressed breast nipple to support the introduction and development of early oral feeding. The pattern of non-nutritive sucking is distinct in that it involves two sucks per second in contrast to nutritive sucking which is one suck per second. Although some literature has identified that non-nutritive sucking has some benefit for the premature infant's feeding development, it is not entirely clear why such an approach is helpful as neurologically, activation of non-nutritive and nutritive skills are different. A summary is presented of the main approaches that use non-nutritive sucking with reference to the literature. This paper also considers other factors and beneficial approaches to managing the introduction of infant feeding. These are: the infant's toleration of enteral feeds pre oral trials, overall development and gestational age when introducing oral experiences, developing swallowing skills before sucking, physiological stability, health status, as well as the development and interpretation of infant oral readiness signs and early communication. [ABSTRACT FROM AUTHOR]

The purpose of this study is to treat dysphagia in a newborn baby with cri du chat syndrome using an oral stimulation intervention and to examine its effects. The subject of this study was a baby born 2 weeks prematurely. Since birth, his oxygen saturation (SaO2) decreased while feeding, and he had difficulty with mouth feeding. Thus, an NG feeding tube was inserted, and dysphagia treatment was initiated on the sixth day after birth. A baseline phase and an intervention phase were performed using an AB design. The oral stimulation intervention was not performed in the baseline phase, as only nonnutritive sucking training using a rubber pacifier was used during the baseline phase. During the intervention phase, nonnutritive sucking training and oral stimulation intervention were simultaneously conducted. After the intervention period, daily oral milk intake and intake per feeding of the subject noticeably increased. The oxygen saturation while feeding rose over 90% on average, and the baby did not present with hypoxia. The oral stimulation intervention provided prior to feeding resulted in highly positive effects, including induced normal development of the baby, stimulation of his transition from the NG feeding tube to bottle feeding, increased oxygen saturation, and a shortened hospital stay. [ABSTRACT FROM AUTHOR]

Aim: Mothers are often advised not to use pacifiers until breastfeeding has been well-established. This study determined the infant and social factors that were related to pacifier use during the first few days of life and whether it led to alterations in feeding performance.Methods: We enroled 51 full-term infants and their mothers at Barnes-Jewish Hospital in urban St. Louis, USA, in 2015. Before they were discharged the mothers completed a questionnaire, and infant feeding was assessed using a standardised assessment.Results: There were 24 (47%) infants who used a pacifier during the first few days of life and seven (29%) of these were exclusively breastfed. Pacifier use was less common among mothers who exclusively breastfed (p = 0.04). Pacifier use was more common among mothers whose income was less than 25 000 US dollars (p = 0.02), who were single (p = 0.002) and who did not have a college education (p = 0.03). No associations between pacifier use and feeding performance were observed.Conclusion: While lower socioeconomic status was related to pacifier use, feeding performance in the first few days of life was no different between those infants who did and did not use pacifiers after a full-term birth. [ABSTRACT FROM AUTHOR]

Purpose: Many pacifier companies advertise that their product is the “best choice” to support proper sucking, feeding, and dental development; however, very little evidence exists to support these claims. As the primary differences across pacifiers are structural and mechanical, the goals of this study were to measure such properties of commercially available pacifiers and to examine how these properties alter suck patterning in healthy, full-term infants. Method: Seven commonly utilized pacifiers were mechanically tested for pull and compression stiffness levels and categorized into nipple shape types based on their aspect ratio. Next, 3 pacifiers (Soothie, GumDrop, and Freeflow) with the most salient differences in pull stiffness levels with 2 different pacifier nipple types were tested clinically on 16 full-term infants (≤ 6 months old) while measuring non-nutritive suck (NNS). Results: A repeated measures analysis of variance revealed significant differences between NNS burst duration (p = .002), NNS cycles per burst (p = .002), and NNS cycles per minute (p = .006) and pacifier type. With each significant dependent measure, pairwise comparisons showed that the GumDrop and Freeflow pacifiers differed significantly on these measures. Conclusions: Pacifier compression, pull stiffness, and nipple shape type yield different NNS dynamics. These findings motivate further investigation into pacifier properties and suck patterning in young infants. [ABSTRACT FROM AUTHOR]

Background. Nonnutritive sucking using a finger or pacifier is a natural reflex for infants. We hypothesized that infants may overfeed if the bottle or breast is constantly offered. Our goal was to determine whether pacifier use in early infancy is associated with lower incidence of obesity at later age. Methods. Parents of 399 infants, 9 to 15 months old, were interviewed and asked whether a pacifier was used consistently for ≥9 months. Body mass indexes at birth, 6 months, and on the day of interview were calculated. Results. In all, 204 (51%) infants used a pacifier, and 195 (49%) were nonusers. More infants in the nonuser group were either overweight--40 (21%)--or obese--32 (16%)--than in the user group--22 (11%) and 22 (11%), respectively (P = .003). Conclusions. Pacifier use in infancy was associated with lower incidence of obesity at 9 to 15 months of age. Offering a pacifier can be protective against infantile obesity. [ABSTRACT FROM AUTHOR]

Background Breastfeeding rates are disproportionately low among young mothers in the United States. Although the use of hospital practices to promote breastfeeding is widely supported, the extent to which these practices help explain breastfeeding disparities by maternal age is unclear. Accordingly, we aimed to explore how maternal age may affect (1) receipt of hospital practices and (2) associations between these practices and exclusive breastfeeding. Methods Data were derived from participants (n = 1598) of Listening to Mothers III, a national survey administered to mothers of singleton births in United States hospitals from July 2011 to June 2012. We used multivariable logistic regression models and interaction terms to examine maternal age as an effect modifier. Results Compared with mothers aged 30 and older, mothers aged 18-19 had lower odds of reporting that nurses helped them initiate breastfeeding when ready ( OR 0.59 [95% CI 0.35-0.99]), they roomed-in with their baby (OR 0.32 [95% CI 0.19-54]) and they did not receive a pacifier ( OR 0.53 [95% CI 0.32-0.90]). Many associations with breastfeeding were stronger among mothers aged 18-19 and 20-24 than mothers aged 25-29 and 30 and older. Additionally, compared with receiving a pacifier, not receiving a pacifier was associated with greater odds of exclusive breastfeeding at 1 week among mothers aged 30 and older (OR 1.47 [95% CI 1.02-2.11]) but lower odds among mothers aged 18-19 (OR 0.26 [95% CI 0.10-0.70]). Conclusions Hospital practices to promote breastfeeding may be differentially implemented by maternal age. Encouraging teenage mothers to room-in with their babies may be particularly important for reducing breastfeeding disparities. Pacifier use among babies of teenage mothers requires further exploration. [ABSTRACT FROM AUTHOR]

Aims and objectives To determine the effects of pacifier use on transition to full breastfeeding and sucking skills in preterm infants. Background Feeding problems in preterm infants cause delays in hospital discharge, extend mother-infant reunification and increase medical cost. Nutritive sucking skills of preterm infants may develop by improving non-nutritive sucking skills and increasing sucking experiences. Design A prospective, randomised controlled trial conducted in the Eastern Turkey. Methods Seventy infants were randomised into two groups: a pacifier group ( n = 34) and a control group ( n = 36). Pacifier use was applied in the preterm infants in the pacifier group, up to switching to full breastfeeding. The infants in the control group did not use pacifiers. Data were collected by a researcher using the Preterm Infant Introductory Information Form, the Preterm Infant Monitoring Form and the LATCH Breastfeeding Assessment Tool. For the study, ethics committee approval, official permission and written informed consents of the families were obtained. Results The time to transition to full breastfeeding (123·06 ± 66·56 hours) and the time to discharge (434·50 ± 133·29 hours) in the pacifier group were significantly shorter compared to the control group (167·78 ± 91·77 and 593·63 ± 385·32 hours, respectively) ( p < 0·05). The weight at transition to full breastfeeding (1944·12 ± 275·67 g) and the weight of discharge (1956·45 ± 268·04 g) in the pacifier group were significantly lower compared to the control group (2155·58 ± 345·57 and 2159·75 ± 341·22 g, respectively) ( p < 0·05). Sucking skills of the infants in the pacifier group at 48 hours after transition to oral feeding and before the discharge was better than in the control group ( p < 0·05). Conclusion Pacifier use improved the sucking skills and shortened the time to transition to full breastfeeding and to discharge in preterm infants receiving complementary feeding. Relevance to clinical practice Pacifier use may be recommended to accelerate transition to full breastfeeding and to improve the sucking skills in preterm infants who were fed by both oral route and complementary feeding in the neonatal intensive care units. [ABSTRACT FROM AUTHOR]

Sleep is a biological necessity. Infants are unique individuals and what can be regarded as normal for one infant and his or her family may be considered a problem for another. Genetics, lifestyles, roles and responsibilities all influence sleep. This article explores the physiology of infant sleep and reviews how sleep is influenced by culture, events such as a hospital admission and parenting styles. It considers how the children's nurse can help and support a family who may feel that they have infant sleep-related issues. A good sleep pattern is essential for a child to succeed at school, reach their full potential and maintain their health and well-being. [ABSTRACT FROM AUTHOR]

Background: The use of pacifiers is an ancient practice, but often becomes a point of debate when parents and professionals aim to protect and promote breastfeeding as most appropriately for nurturing infants. We discuss the current literature available on pacifier use to enable critical decision-making regarding justifiable use of pacifiers, especially in the Baby-Friendly Hospital Initiative context, and we provide practical guidelines for clinicians.Discussion: Suck-swallow-breathe coordination is an important skill that every newborn must acquire for feeding success. In most cases the development and maintenance of the sucking reflex is not a problem, but sometimes the skill may be compromised due to factors such as mother-infant separation or medical conditions. In such situations the use of pacifiers can be considered therapeutic and even provide medical benefits to infants, including reducing the risk of sudden infant death syndrome. The argument opposing pacifier use, however, is based on potential risks such as nipple confusion and early cessation of breastfeeding. The Ten Steps to Successful Breastfeeding as embedded in the Baby-Friendly Hospital Initiative initially prohibited the use of pacifiers in a breastfeeding friendly environment to prevent potential associated risks. This article provides a summary of the evidence on the benefits of non-nutritive sucking, risks associated with pacifier use, an identification of the implications regarded as 'justifiable' in the clinical use of pacifiers and a comprehensive discussion to support the recommendations for safe pacifier use in healthy, full-term, and ill and preterm infants. The use of pacifiers is justifiable in certain situations and will support breastfeeding rather than interfere with it. Justifiable conditions have been identified as: low-birth weight and premature infants; infants at risk for hypoglyceamia; infants in need of oral stimulation to develop, maintain and mature the sucking reflex in preterm infants; and the achievement of neurobehavioural organisation. Medical benefits associated with the use of pacifiers include providing comfort, contributing towards neurobehavioural organisation, and reducing the risk of sudden infant death syndrome. Guidelines are presented for assessing and guiding safe pacifier use, for specific design to ensure safety, and for cessation of use to ensure normal childhood development. [ABSTRACT FROM AUTHOR]

Swaddling promotes quiet sleep and may be a useful strategy to encourage infant safe sleep practices. We explored the effect of a swaddling education intervention on infant sleep practices in an urban minority community. We compared a cohort of postpartum mothers who were given education about swaddling to a historical group. Breastfeeding and pacifier use were similar in both groups. Compared to the historical group (n = 121), mothers in the swaddling group (n = 40) were more likely to swaddle infants to sleep (52.5 vs. 23.1 %, p = .001) and less likely to bedshare (15.4 vs. 33.1 %, p = .042). No significant effect was reported on infant supine sleep (81.6 vs. 69.4 %, p = .212). A postpartum swaddling education intervention had a limited impact on infant safe sleeping practices in an urban minority community. A recent metaanalysis demonstrated an increased risk of sudden infant death in infants swaddled for sleep and recommended the need to avoid the prone and side sleep position, especially for swaddled infants, and to set an age and developmentally appropriate limit for the use of swaddling. Ongoing studies are needed to monitor the safety and effectiveness of swaddling as a tool to promote safe sleeping in infants. [ABSTRACT FROM AUTHOR]

Background. The authors studied the effects of nonnutritive sucking behavior (NNSB) on malocclusions through a systematic review of association (etiology). Types of Studies Reviewed. The authors performed a 3-step search strategy, including electronic searches. Studies of healthy participants with a history of active or previous NNSB, for whom specific malocclusion outcomes had been assessed, were eligible for inclusion. The authors considered before-and-after studies, prospective and retrospective (longitudinal) studies, case-control studies, and analytical cross-sectional studies. They excluded reviews, text-and opinion-based articles, conference abstracts, case reports, case-series, and descriptive cross-sectional studies. The authors, using standardized instruments, independently assessed methodological quality and extracted data from the included studies. In situations for which there were sufficient studies, the authors conducted meta-analyses using the random-effects model, supplemented with the fixed-effects model in situations for which statistical heterogeneity was less than 50%, which the authors assessed using the I2 statistic. Results. The authors included 15 identified studies. They found that NNSB was associated with varying risks of developing malocclusions. Pacifier suckers are less likely to develop an increased overjet compared with digit suckers, although the results of a meta-analysis of 7 studies whose investigators had assessed posterior crossbite in the primary dentition demonstrated a significant association with pacifier sucking over digit sucking (n = 5,560; risk ratio, 1.42; 95% confidence interval, 1.18-1.70; P = .0001). Longer duration of NNSB was associated with an increased risk of developing malocclusions. Across-study heterogeneity likely resulted from methodological and sample size differences. Conclusions. The authors of this study have confirmed the association between NNSB and the development of malocclusions. This study provides the highest level of evidence on this topic. Pacifiers were associated with a higher risk of developing most malocclusion features when compared with digit sucking. Practical Implications. Though malocclusions are of multifactorial etiology, clinicians should inform parents and caregivers about the dental risks of NNSB, an environmental factor that is modifiable. NNSB should be discouraged in order to avoid the development of malocclusions. Future studies should adopt standardized, universally agreed and accepted definitions and classifications when measuring and reporting orthodontic outcome measures. This will help achieve across-study homogeneity. [ABSTRACT FROM AUTHOR]

Approximately 3500 infants die annually in the United States from sleep-related infant deaths, including sudden infant death syndrome (SIDS), ill-defined deaths, and accidental suffocation and strangulation in bed. After an initial decrease in the 1990s, the overall sleep-related infant death rate has not declined in more recent years. Many of the modifiable and nonmodifiable risk factors for SIDS and other sleep-related infant deaths are strikingly similar. The American Academy of Pediatrics recommends a safe sleep environment that can reduce the risk of all sleep-related infant deaths. Recommendations for a safe sleep environment include supine positioning, use of a firm sleep surface, room-sharing without bed-sharing, and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include avoidance of exposure to smoke, alcohol, and illicit drugs; breastfeeding; routine immunization; and use of a pacifier. New evidence and rationale for recommendations are presented for skin-to-skin care for newborn infants, bedside and in-bed sleepers, sleeping on couches/ armchairs and in sitting devices, and use of soft bedding after 4 months of age. In addition, expanded recommendations for infant sleep location are included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, "SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment," which is included in this issue. [ABSTRACT FROM AUTHOR]

Approximately 3500 infants die annually in the United States from sleep-related infant deaths, including sudden infant death syndrome (SIDS; International Classification of Diseases, 10th Revision [ICD-10], R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75). After an initial decrease in the 1990s, the overall death rate attributable to sleep-related infant deaths has not declined in more recent years. Many of the modifiable and nonmodifiable risk factors for SIDS and other sleep-related infant deaths are strikingly similar. The American Academy of Pediatrics recommends a safe sleep environment that can reduce the risk of all sleep-related infant deaths. Recommendations for a safe sleep environment include supine positioning, the use of a firm sleep surface, room-sharing without bed-sharing, and the avoidance of soft bedding and overheating. Additional recommendations for SIDS reduction include the avoidance of exposure to smoke, alcohol, and illicit drugs; breastfeeding; routine immunization; and use of a pacifier. New evidence is presented for skin-to-skin care for newborn infants, use of bedside and in-bed sleepers, sleeping on couches/armchairs and in sitting devices, and use of soft bedding after 4 months of age. The recommendations and strength of evidence for each recommendation are included in this policy statement. The rationale for these recommendations is discussed in detail in the accompanying technical report (www.pediatrics.org/cgi/doi/10.1542/ peds.2016-2940). [ABSTRACT FROM AUTHOR]

Vaccinations are often associated with anxiety, avoidance, and considerable distress for children and parents. These issues can also impair coping during future health care visits. Parents, children, and clinicians can benefit from strategies designed to enhance coping. However, an important barrier to implementation of coping strategy interventions is lack of knowledge among both parents and staff. We produced two sets of tailored handouts designed to enhance education for primary care staff and parents using 41 clinical guidelines, reviews, and randomized controlled trials. Articles were selected from vaccine-specific literature by relevance and practicality for primary care. Handouts provide suggestions for parent and staff interventions before, during, and after vaccinations, focusing on techniques that are effective, cost-efficient, and adaptable. For children of all ages, tailored adult vocabulary and tone can also support coping. [ABSTRACT FROM AUTHOR]

The article discusses research on the analgesic practices for pain management during childhood vaccination injections in Lisbon, Portugal. Topics covered include pain strategies used during the injections, such as pacifier and breastfeeding, opportunities for improvement in vaccination pain mitigation for different areas identified in the study, and the need for educational programmes for effective analgesic strategies.

Purposes: Pacifiers are the most common device used by children to satisfy their sucking needs. Because of their design, reports of anterior open bite and increased overjet are common. The purposes of this pilot study were to measure the effects of a unique pacifier in toddlers who have existing open bites and increased overjets; and secondly to determine the feasibility of recruiting and retaining toddlers for a six-month study. Methods: Toddlers with existing open bite and increased overjet currently using a conventional pacifier were recruited from a university pediatric dental clinic. Base- line information was obtained. Visual examination and intraoral measurements were obtained. he study pacifier was introduced to replace the existing pacifier. Follow- up data was collected at three and six months post-intervention. Results: Eight of the 11 toddlers (73 percent) completed the study. Recruitment was challenging because of the inclusion criteria and transportation; retaining participants required numerous reminders to parents. here was a significant difference between initial and final open bite and overjet measurements. Conclusion: It is feasible to recruit and retain toddlers but it required significant staff interventions. There was a significant improvement in reducing existing open bite and overjet with the pacifier after six months. [ABSTRACT FROM AUTHOR]