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Consequences of bottle-feeding to the oral facial development of initially breastfed children

Authors:
Karina Camilo Carrascoza
Karina Camilo Carrascoza
Possobon Rosana de Fátima at State University of Campinas (UNICAMP)
Possobon Rosana de Fátima
Laura Mendes Tomita
Laura Mendes Tomita
Laura Mendes Tomita
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Antonio Bento Moraes at State University of Campinas (UNICAMP)
Antonio Bento Moraes
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Abstract

To identify and assess the possible consequences of bottle-feeding on the oral facial development of children who were breastfed up to at least six months of age. Two hundred and two children (4 years of age) enrolled in an early health attention program participated in the study. The sample was divided into two groups: G1 (children who used only a cup to drink) and G2 (those who used a bottle). Lip closure was observed in 82% of the children in G1 and in 65% of those in G2 (p = 0.0065). The tongue coming to rest in the maxillary arch was found in 73% of the children in G1 and in 47% of those in G2 (p = 0.0001). Nasal breathing was observed in 69% of G1 and in 37% of G2 (p = 0.0001). The maxilla was shown to be normal in 90% of G1 and in 78% of G2 (p = 0.0206). Use of the bottle, even among breastfed children interferes negatively with oral facial development.
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1. Doutoranda em Saúde da Criança e do Adolescente, Faculdade de
Ciências Médicas, Universidade Estadual de Campinas (UNICAMP),
Campinas, SP, Brasil.
2. Professora Doutora, Faculdade de Odontologia de Piracicaba, UNICAMP,
Piracicaba, SP, Brasil.
3. Doutoranda em Odontologia, Faculdade de Odontologia de Piracicaba,
UNICAMP, Piracicaba, SP, Brasil.
4. Doutor. Professor titular, Faculdade de Odontologia de Piracicaba,
UNICAMP, Piracicaba, SP, Brasil.
Manuscript received Feb 02 2006, accepted for publication May 25 2006.
Suggested citation: Carrascoza KC, Possobon RF, Tomita LM, de Moraes
AB. Consequences of bottle-feeding to the oral facial development of
initially breastfed children. J Pediatr (Rio J). 2006;82:395-7.
0021-7557/06/82-05/395
Jornal de Pediatria
Copyright © 2006 by Sociedade Brasileira de Pediatria
doi:10.2223/JPED.1536
Consequences of bottle-feeding
to the oral facial development
of initially breastfed children
Karina Camillo Carrascoza,
1
Rosana de Fátima Possobon,
2
Laura Mendes Tomita,
3
Antônio Bento Alves de Moraes
4
Abstract
Objective: To identify and assess the possible consequences of bottle-feeding on the oral facial development
of children who were breastfed up to at least six months of age.
Method: Two hundred and two children (4 years of age) enrolled in an early health attention program
participated in the study. The sample was divided into two groups: G1 (children who used only a cup to drink) and
G2 (those who used a bottle).
Results: Lip closure was observed in 82% of the children in G1 and in 65% of those in G2 (p = 0.0065). The
tongue coming to rest in the maxillary arch was found in 73% of the children in G1 and in 47% of those in G2
(p=0.0001). Nasal breathing was observed in 69% of G1 and in 37% of G2 (p = 0.0001). The maxilla was shown
to be normal in 90% of G1 and in 78% of G2 (p = 0.0206).
Conclusion: Use of the bottle, even among breastfed children interferes negatively with oral facial development.
J Pediatr (Rio J). 2006;82(5):395-7: Bottle feeding, breastfeeding.
Introduction
Breastfeeding is a determining factor for adequate
craniofacial development, because it promotes intense
exercise of the orofacial muscles, thus favorably stimulating
the functions of breathing, swallowing, chewing and
phonation.
1
The nipple-squeezing movements favor
adequate lip closure during rest
2
and the correction of
physiological mandibular retrognathism. In addition, these
movements promote correct tongue positioning in the
central incisor palatine region, due to the tonicity acquired
with the intense activity of tongue muscles.
3
In spite of the measures to promote breastfeeding
carried out in baby friendly hospitals
4
and the legal
discouragement of bottle feeding in Brazil,
5
there is
evidence that there are two critical times for introducing
the bottle: soon after birth and around four months of
age.
6
The first situation occurs as a result of problems
associated with breastfeeding that make it difficult for the
child to gain weight. In this case, it is common for health
professionals to prescribe infant formulas, generally offered
in the bottle, to supplement/replace the mothers milk 
although the correct measure would be to investigate the
difficulties presented by the nursing mother and offer
guidance about breastfeeding management.
7
Introduction of the bottle to the childs feeding routine
around the fourth month of life is probably related to the
end of the mothers maternity leave in Brazil and her
return to work. This is a moment characterized by many
conflicts, such as the choice of a caretaker for the baby and
the form of feeding in the absence of the mother.
8
Mothers
who choose to leave their child in institutions (daycare
centers/schools), where the use of the bottle is generally
established, cannot demand the use of cups. The
BRIEF COMMUNICATION
395
396 Jornal de Pediatria - Vol. 82, No.5, 2006
Bottle-feeding and oral facial development  Carrascoza CK et al.
professionals in these institutions justify this practice by
the small number of staff in relation to the number of
children and the degree of difficulty associated with
feeding small children with a cup.
9
The literature is consistent in affirming that to use a
bottle to the detriment of breastfeeding has consequences
for the childs health.
10
There is no study, however,
describing the effects of using a bottle on the oral facial
development of children who were given a bottle while also
being breastfed up to the sixth month of life.
This being so, the objective of this study was to identify
and assess the possible consequences of the use of a
feeding bottle on the oral facial development of children
who were breastfed (either exclusively or not) up to at
least 6 months of age.
Methods
The participants were 202 children (age: 4 years)
attending the Research and Dental Treatment Center for
Special Patients (Centro de Pesquisa e Atendimento
Odontológico para Pacientes Especiais  Cepae) at the
Piracicaba Dentistry School, State University of Campinas
(UNICAMP) in 2004. Cepae provides care to children from
the prenatal period through to the fifth year of life. The
pregnant mother participates in educational lectures, and
after the birth the mother-child pair participates in the
Group to Encourage Exclusive Breastfeeding, from which
they receive support to maintain breastfeeding and avoid
introducing the bottle/pacifier. At 3, 4 and 5 years of age,
the children go through dental and speech assessment,
one of the activities offered by Cepae.
Group 1 was composed of all the children participating
in Cepae who used only a cup to ingest liquid foods up to
4 years of age (they never used a bottle) (n=101). In
order for Group 2 to include the same number of children
as G1, the sample was randomly selected from among the
Cepae patients who used a bottle for at least 1 year. Thus
it was not necessary to calculate the sample size.
The sample included children breastfed for a minimum
of 6 months, while those who presented other sucking
habits apart from the feeding bottle (pacifier/finger) were
excluded. These criteria were meant to avoid the
interference of these variables in the investigation of
specific consequences of bottle use on oral facial
development.
In the orthodontic and speech assessment, all the
children were examined by a dentist and a speech therapist.
Those professionals were previously trained by the
researchers in order to standardize the exam, but were
not informed of the study objectives. The following data
were noted: (1) occlusion: anterior open bite (absence of
contact between the maxillary and mandibular incisors
during posterior tooth occlusion); posterior crossbite
(contact between the vestibular cusp tips of the maxillary
posterior teeth and occlusal grooves of the mandibular
posterior teeth); muscle aspects: lip posture (presence/
absence of contact between the upper and lower lips
during rest); tongue resting place (between the arches, in
the maxillary or mandibular arch); (3) articulation: dental
phonemes /t/, /d/, /n/, /l/ and alveolar phonemes /s/ and
/z/ (phonological mismatches were not considered, but
rather phonetic changes, which result from impaired
articulation); (4) breathing pattern: mouth breathing,
nose breathing and mixed (predominantly nasal or
predominantly oral); (5) Palate depth: normal or high
arched palate; (6) maxillary arch shape: atresic or
semicircular: (7) face: symmetry or asymmetry.
The statistical analyses were performed using the chi-
square and exact Fisher tests (level of significance = 5%).
This study was approved by the Research Ethics
Committee at the Piracicaba Dentistry School, UNICAMP
(Protocol No. 084/2004).
Results
Lip closure was observed in 65% of bottle users and in
82% of cup users (p = 0.0065). With regard to the tongue
resting place, among the children who used cups, 73%
presented tongue resting in the maxillary arch (desirable).
Among the children who used feeding bottles, 53%
presented tongue resting in the mandibular arch or between
the arches (a change from normality), revealing
hypotonicity of tongue muscles (p < 0.0001).
There was greater occurrence of nose breathing among
children using cups (69%). Among those who used a
bottle, 63% presented mouth or mixed breathing
(p<0.0001). The shape of the maxillary arch was different
in the two groups, maxillary atresia being present in 22%
of the bottle users and in 10% of the cup users (p=0.0206).
There was no difference between the groups in terms of
malocclusion, articulation, palate depth and presence of
facial asymmetry (p > 0.05).
Discussion
There was statistical difference between the groups as
regards lip closure, which was predominant among cup
users, showing the positive influence of the movements
performed while sucking the mothers milk.
2
In addition to
lip closure, the sucking movements associated with
breastfeeding favor tongue positioning in the palatal
region of the central incisors, since the intense activity of
the tongue muscles promotes tonicity
3
and prevents air
from passing through the mouth, thus favoring the
establishment and maintenance of nose breathing. This
type of breathing not only heats, humidifies and filters the
air before it reaches the lungs, but is considered the
Jornal de Pediatria - Vol. 82, No.5, 2006 397
Correspondence:
Karina Camillo Carrascoza
Avenida Limeira, 901, Bairro Areião
CEP 13414-903  Piracicaba, SP  Brazil
Tel.: +55 (19) 3412.5363
Fax: +55 (19) 3412.5218
E-mail: carrascoza@fop.unicamp.br
References
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Ortop Facial. 2001;6:111-21.
2. Serra-Negra JMC, Pordeus IA, Rocha Jr JF. Estudo da associação
entre aleitamento, hábitos bucais e maloclusões. Rev Odontol
Univ Sao Paulo. 1997;11:79-86.
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implicações para o desenvolvimento motor-oral. J Pediatr (Rio
J). 2003;79:7-12.
4. Vannuchi MTO, Monteiro CA, Rea MF, Andrade SM, Matsuo T.
Iniciativa Hospital Amigo da Criança e aleitamento materno em
unidade de neonatologia. Rev Saude Publica. 2004;38:422-8.
5. Norma brasileira para comercialização de alimentos para
lactentes. International baby food action network. Resoluções
da Diretoria Colegiada /ANVISA. 2002. http://www.ibfan.org.br/
rdc222.htm. Access: 23/06/2006.
6. Oliveira RL, Silva AN. Aspectos legais do aleitamento materno:
cumprimento da lei por hospitais de médio e de grande porte de
Maceió. Rev Bras Saude Matern Infant. 2003;3:43-8.
7. Rea MF. Reflexões sobre a amamentação no Brasil: de como
passamos a 10 meses de duração. Cad Saude Publica. 2003;19:
S37-S45.
8. Lamounier JA. O efeito de bicos e chupetas no aleitamento
materno. J Pediatr (Rio J). 2003;79:284-6.
9. Dowling DA, Meier PP, DiFiori JM, Blatz MA, Martin RJ. Cup-
feeding for preterm infants: mechanics and safety. J Hum Lact.
2002;18:13-20.
10. Jorge MD. Hábitos bucais - Interação entre odontopediatria e
fonoaudiologia. J Bras Odontop Odont Bebe. 2002;5:342-50.
11. Legovic M, Ostric L. The effects of feeding methods on the
growth of the jaws in infants. ASDC J Dent Child. 1991;58:253-5.
12. Ferreira MIDT, Toledo OA. Relação entre tempo de aleitamento
materno e hábitos bucais. Rev ABO Nac. 1997;5:317-20.
13. Fagundes ALA, Leite ICG. Amamentação e maloclusão: revisão
de literatura. J Bras de Fonoaudiologia. 2001;2:229-32.
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seus fatores etiológicos e conseqüências sobre o processo de
crescimento/desenvolvimento da face. Rev Dent Press Ortod
Ortop Facial. 2000;5:66-79.
functional matrix for maxilla growth. The passage of air
through the nose exerts pressure on the palate, causing it
to be lowered and to expand. This phenomenon enables
the face bones to accompany body growth, generating
space for the teeth to erupt adequately.
11
When the bottle is used, the tongue acts only to control
the milk outlet, and becomes hypotonic and incapable of
remaining in the most adequate position.
10
This observation
confirms the results of the present study as regards the
greater occurrence of hypotonicity, resulting in the tongue
resting in the incorrect place among bottle users. The
absence of a function for the tongue, causing it to rest on
the maxillary arch, allows air to enter through the mouth,
thus compromising nose breathing.
12
Once again, the
results of this study corroborated the findings reported in
the literature, when it showed that over 60% of the
children who used bottles presented mouth or mixed
breathing.
The absence of air passing through the nose causes
maxillary arch atresia.
13
This relation was also observed
in our study, in which bottle users presented more
maxillary atresia. The tongue resting in the mandibular
arch may also act as a functional matrix for inadequate
mandibular growth. This occurrence, associated with the
passage of air through the nose, may lead to the
development of posterior crossbite. An additional
consequence is described by Köhler,
14
who states that the
buccinator, the muscle responsible for obtaining milk from
the bottle, becomes hypertrophic with prolonged suction,
thus disproportionately aggravating maxilla/mandibular
growth. This inadequate tonicity not only causes crossbite
and dental crowding, but may lead to sequential alterations
in the face, such as excessive narrowing of the maxilla,
palate atresia and septal deviation, and compromise the
esthetic appearance and function of the nose.
The results of the present study showed no statistical
difference between the groups as regards occlusion. It is
worth pointing out, however, that the children were
examined at an age (36 months) in which they may still be
too young to present posterior crossbite. This hypothesis
is reinforced by the greater occurrence of the two factors
that lead to posterior crossbite among bottle users:
maxillary atresia and the tongue being positioned in the
mandibular arch. Since the results of this study showed no
evidence of the direct relation between posterior crossbite
and the use of feeding bottles, it is suggested that a study
of older subjects be made.
Thus, the results of this study showed that the use of
the feeding bottle, even among children who were
breastfed, interferes negatively with oral facial
development.
Bottle-feeding and oral facial development  Carrascoza CK et al.
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Assessing the impact of breastfeeding on oral health and facial development
Chapter
Full-text available
  • Jan 2024
Breastfeeding emerges as an essential pillar for child health and development, not only as a balanced nutritional source, but as an agent that promotes the affective bond between mother and child. The relevance of this act transcends food barriers, encompassing fundamental benefits for the baby's immune system, strengthening the foundations for their psychological and physical development. Thus, this study proposes a literature review of the influence of breastfeeding on facial growth and development. Breastfeeding has a significant impact on many aspects, from the development of the teeth to the facial structure. In addition, it contributes to the improvement of essential sucking, chewing, swallowing and breathing movements. This positive interaction culminates in a proper bite and sustains a better future quality of life. This establishes a dynamic balance between the facial anatomy and the oral cavity. Thus, the crucial role of dentists in promoting breastfeeding is concluded. In addition to dental practices, these professionals have the potential to guide mothers about the intrinsic importance of breastfeeding, not only as a nutritional factor, but also as an essential determinant for the proper development of the child. This comprehensive approach, both nutritionally and skeletally, converges towards harmonious orofacial growth, positively influencing the child's oral and overall health.
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First Thousand Days of Child Life and the Development of Risk Factors for Malocclusions
Article
Full-text available
  • Oct 2023
Objective To identify the association between individual and socioeconomic factors during the first thousand days of the child's life and the occurrence of risk behaviors for the development of malocclusions. Material and Methods Cross-sectional study. A sample of 655 6-year-old schoolchildren and families was included. Interviews with mothers were performed at home. The dependent variables were risk behaviors to the development of malocclusions. Independent variables were socioeconomic conditions, aspects of gestation, birth and health of the child up to two years of age. Bivariate and multivariate analyzes were performed through Poisson regression. Results Maternal education of less than eight years was independently associated with the interruption of exclusive breastfeeding until the fourth month (PR=1.58 CI 95%; 1.07; 2.37). Occupation of the mother with income [PR=1.26; 1.02; 1.56)], occupation of the father without income [PR=1.46 (1.01; 2.14)] were associated fwith interruption of breastfeeding until the sixth month. Pregnancy in adolescence [PR=0.83 (0.70; 0.98)] and nursery attendance [PR=1.15 (1.02; 1.28)] were associated with bottle use. Nursery attendance [PR=1.27 (1.01; 1.59)], hospitalization in the first 29 days of life [PR=1.34 (1.01; 1.80)], occurrence of reflux [PR=1.30 (1.01; 1.70)] were associated with pacifier using. Conclusion Variables related to the period of the first thousand days of life are associated with higher risk behaviors for the occurrence of malocclusions. Keywords: Child Development; Child Health; Orthodontics; Breast Feeding; Habits
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Nasal Congestion, Severity and Breathing Routes in OSA閉塞性睡眠時無呼吸の鼻閉と重症度と呼吸経路
Article
  • Apr 2023
Objectives: The purposes of this study were to determine what each of the nasal resistance values means and which nasal resistance values reflect the degree of nasal congestion, and to examine which factors are correlated with the severity of obstructive sleep apnea (OSA), and how oral breathing affects OSA. Methods: The correlations among the nasal resistance values obtained by anterior rhinomanometry (inspiration, expiration, bilateral, ipsilateral, laterality) were examined in 613 cases diagnosed as having OSA. Correlations of the nasal resistance values with the oxygen desaturation index (ODI)3% and anthropometric measurements, the morbidity period of snoring, and the period of apnea obtained from a questionnaire were investigated. The patients were then classified into three groups according to the degree of nasal congestion (often, sometimes, never), and the breathing route (oral, oronasal, nasal) obtained from the questionnaire and each of the factors were compared among the groups. Results: Higher values and lower values of nasal resistance were positively correlated with the laterality and bilateral values, respectively (p < 0.001). The ODI3% was positively correlated with the BMI, cervical circumference, and morbidity period of snoring and period of apnea (p < 0.001), but not with any of the nasal resistance values. Laterality of nasal resistance during inspiration and the proportion of oral-breathing patients were higher in the often-nasal congestion group (p < 0.001). The onset of snoring was significantly earlier in the oral-breathing group than in the other groups (p < 0.001). Conclusion: The laterality of nasal resistance during inspiration reliably indicated the severity of nasal congestion. The morbidity period of snoring and that of apnea were both correlated with the ODI3%, which suggests that repetitive snoring and apnea over the long term might contribute to the severity of OSA. There was no correlation between any of the nasal resistance values and the ODI3%. The onset of snoring at a young age was related with oral breathing, which might cause OSA.
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Iniciativa Hospital Amigo da Criança e aleitamento materno em unidade de neonatologia
Article
Full-text available
  • Jun 2004
OBJETIVO: Avaliar o impacto da iniciativa Hospital Amigo da Criança sobre a prática do aleitamento materno durante a internação de recém-nascidos em unidade de neonatologia e durante os primeiros seis meses de vida. MÉTODOS: Foram consultados todos os prontuários de recém-nascidos internados em unidade de neonatologia de um hospital de ensino durante os anos de 1994 (N=285) e 1998 (N=368). Foram analisadas informações sobre o regime alimentar durante a internação e após a alta hospitalar, até os primeiros seis meses de vida. Para estimar a duração do aleitamento materno e do aleitamento materno exclusivo e as diferenças entre os dois anos, foram utilizados a técnica de Kaplan-Meier e o teste de Log-Rank. Análises de regressão logística e de Cox foram aplicadas para controlar variáveis de confusão. RESULTADOS: Durante o período de internação, houve aumento expressivo do percentual de crianças em aleitamento materno exclusivo (de 1,9%, em 1994, para 41,7%, em 1998) e alimentação exclusiva por fórmula, que era de 17,9%, em 1994, e deixou de existir em 1998. Quanto à amamentação nos primeiros seis meses de vida, o tempo mediano do aleitamento materno exclusivo aumentou de 12 para 45 dias. Para o aleitamento materno, que inclui a ingestão de outros alimentos, não houve diferença significativa. CONCLUSÕES: A implantação da iniciativa do hospital estudado contribuiu para aumentar o índice de aleitamento materno exclusivo durante a internação de recém-nascidos em uma unidade de neonatologia e nos primeiros seis meses de vida.
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Aspectos legais do aleitamento materno: cumprimento da lei por hospitais de médio e de grande porte de Maceió
Article
Full-text available
  • Mar 2003
OBJETIVOS: verificar o cumprimento da legislação brasileira sobre o aleitamento materno por hospitais de médio e grande porte no município de Maceió, durante o ano 2000. MÉTODOS: estudo descritivo para o qual foram selecionados os hospitais públicos e privados de médio e grande porte de Maceió em que trabalhassem pelo menos 30 mulheres com mais de 16 anos de idade. As seguintes variáveis foram determinadas: número de funcionárias, disponibilidade de locais de amamentação e de berços em cada hospital. Os dados foram colhidos através de entrevista semi-estruturada, baseada na legislação vigente, e em visitas aos locais de guarda dos filhos das nutrizes. RESULTADOS: a) 17 hospitais concedem os 120 dias de licença-maternidade e os dois descansos de 30 minutos cada, destinados à amamentação conforme legislação; b) 10 não têm local reservado para os bebês de suas funcionárias; c) em relação as creches, nenhuma segue as normas básicas de funcionamento estabelecidas na legislação. CONCLUSÕES: os hospitais cumprem só parcialmente a legislação e existe descaso dos órgãos competentes na fiscalização do cumprimento das leis de proteção ao aleitamento materno.
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Reflexões sobre a amamentação no Brasil: De como passamos a 10 meses de duração
Article
Full-text available
  • Jan 2003
Se em 1975 uma em cada duas mulheres amamentava apenas até o segundo ou terceiro mês no Brasil, no último inquérito de 1999, uma em cada duas mulheres amamenta até cerca de dez meses. Esse aumento em 25 anos pode tanto ser pensado como um sucesso, como pode ser visto como algo que poderia estar muito melhor se todas as atividades que se realizaram no país tivessem sido mantidas, avaliadas, corrigidas, bem coordenadas, melhoradas. Diversas foram as decisões de organismos internacionais de saúde no período, assim como estudos sobre aleitamento que reorientaram ações. Propomo-nos a tentar rever a trajetória do programa nacional, privilegiando a análise da influência das políticas internacionais e analisando-o em quatro períodos: de 1975 a 1981 (quando pouco era feito), de 1981 a 1986 (as campanhas na mídia), de 1986 a 1996 (políticas em prol da amamentação) e de 1996 a 2002 (planejamento e ações de capacitação de recursos humanos com o respaldo das políticas de proteção). O desafio que se coloca para o futuro é a necessidade de continuar a promover a amamentação exclusiva até o sexto mês, levando em conta grupos particulares da população.
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Desmame precoce: Implicações para o desenvolvimento motor-oral
Article
Full-text available
  • Feb 2003
  • J Pediatr
Objetivo: revisar as estreitas relações entre o desmame precoce e seus reflexos no desenvolvimento motor-oral, enfocando as conseqüências na oclusão, respiração e aspectos motores orais da criança. Fonte de dados: foi realizada uma pesquisa bibliográfica relacionada às áreas de pediatria, odontologia e fonoaudiologia, através do Medline, entre o ano de 1960 e o ano 2001. Síntese dos dados: a partir da literatura levantada, pode-se observar que o desmame precoce pode levar à ruptura do desenvolvimento motor-oral adequado, podendo prejudicar as funções de mastigação, deglutição, respiração e articulação dos sons da fala, ocasionar má-oclusão, respiração oral e alteração motora oral. Conclusões: pode-se concluir que além dos inúmeros benefícios do aleitamento materno, este contribui para o desenvolvimento motor-oral adequado e previne alterações fonoaudiológicas, no que se refere ao sistema motor-oral.
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Estudo da associação entre aleitamento, hábitos bucais e maloclusões
Article
  • Apr 1997
A proposta do presente trabalho foi associar a forma de aleitamento com a instalação de hábitos bucais deletérios e conseqüentes maloclusões. Foram examinadas 357 crianças, na faixa etária de 3 a 5 anos, pertencentes a creches e escolas da cidade de Belo Horizonte. Para a obtenção de informações sobre o desenvolvimento das crianças, foram enviados questionários para as mães. Houve um retorno de 289 questionários, sendo avaliadas 289 fichas das crianças participantes. Constatou-se que há associação do aleitamento natural com a não instalação de hábitos bucais viciosos, pois 86,1% das crianças que não apresentaram hábitos deletérios foram aleitadas por, no mínimo, 6 meses. A associação de hábitos bucais com maloclusões foi significante, sendo mais prevalentes as mordidas cruzada posterior e aberta anterior
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Cup-Feeding for Preterm Infants: Mechanics and Safety
Article
  • Mar 2002
Cup-feeding is recommended for breastfed preterm infants to avoid artificial nipples. However, the oral mechanisms used in cup-feeding, or its safety and efficacy, have not been described. The authors measured sipping, breathing, SaO2, and volume of intake during 15 cup-feeding sessions for 8 infants (mean gestational age at birth was 30.6 weeks). Mean duration of sipping bursts and pauses was 3.6 seconds and 28.1 seconds, respectively. Mean breathing rate during bursts and pauses was similar (46.2 +/- 24.3 vs 45.7 +/- 17.7, respectively), with SaO2 > or = 90% during all bursts. Mean duration of cup-feedings was 15.2 +/- 3.9 minutes (range, 11.0-23.3), whereas mean volume of intake was only 4.6 +/- 2.2 mL (range, 1.5-8). For the 15 sessions, 38.5% of milk taken from the cup was recovered on the bib. Although infants remain physiologically stable, cup-feeding has questionable efficacy and efficiency. Differentiating between actual intake versus spillage of milk merits attention.
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[The influence of nipples and pacifiers on breastfeeding duration]
Article
  • Jul 2003
  • J Pediatr
* Fac. de Medicina UFMG, Programa de Pós-graduação em Pediatria. As chupetas e bicos são largamente utilizados em vários países, constituindo importante hábito cultural em nosso meio. As chupetas são geralmente usadas para acal- mar o bebê e não fornecem alimentação; seu uso pode levar à menor freqüência de amamentar. Com isto, a estimulação do peito e a retirada do leite da mama podem ficar diminu- ídas, levando à menor produção do leite, cuja conseqüência é levar ao desmame. Além disso, as chupetas como os bicos podem ser nocivos por transmitirem infecções, por reduzi- rem o tempo gasto sugando no peito e interferir na amamen- tação, levando ao desmame. Podem também prejudicar a função motora oral, exercendo papel importante na síndro- me do respirador bucal, e também levar a problemas ortodônticos provocados pela sucção do bico, que não estimula adequadamente os músculos da boca1-3. Uma grande parte dos profissionais da saúde, assim como leigos e mães, acredi- tam que as chupetas são inofensivas, ou até mesmo necessárias e benéficas para o desenvolvimento do bebê, tendo uma atitude indiferente ou permissiva. O uso de chupetas é muito difundido entre as mães brasileiras, e uma pesquisa nas capitais brasileiras mostrou uma prevalência de 60,3% de uso em crianças4. No Brasil, com o objetivo de restringir a promoção do uso de chupetas e bicos junto ao público, a Agência Nacional de Vigilância Sanitária (ANVISA) decidiu incluir, na embalagem do produto, a inscrição "O Ministério da Saúde adverte: a criança que mama no peito não necessita de mamadeira, bico ou chupeta. O uso de mamadeira, bico ou chupeta prejudica a amamentação e seu uso prolongado prejudica a dentição e a fala da criança". Essa medida tem como finalidade desencorajar a mãe a trocar o aleitamento natural pelo artificial. Diversos estudos mostram associação significativa en- tre uso da chupeta e menor duração do aleitamento materno, portanto, evidenciando a necessidade de maiores informa- ções à população e aos profissionais da saúde sobre tais efeitos. Os estudos que analisam a associação entre o uso de chupetas e a duração da amamentação são consistentes, sendo que em alguns há evidências de uma relação dose- resposta5-7. No entanto, não ficou ainda bem estabelecida a relação causal. A chupeta poderia ser introduzida já como conseqüência de problemas na amamentação, porém o seu uso poderia também diminuir a freqüência de mamadas no seio, e como conseqüência a diminuição da produção de leite8,9. Assim, autores destacam a importância do aspecto cultural envolvido nesta prática e enfatizam que o uso de chupeta deve ser visto como um indicador de problemas com a amamentação10-12.
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