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Background. Occupational therapy practice for oral feeding assessment is based on clinical observation of infants' sucking, swallowing, and breathing ability, which is influenced by clinical experience and provides poor evidence on explanatory factors. Purpose. To test the clinical utility and safety of a nipple monitoring device for the quantitative evaluation of oral feeding skills. Method. Sixteen infants, with no severe medical complications, participated in a pre-experimental pilot study. Oral feeding performances (duration, intake volume, and rate of transfer), and occurrence of adverse events (apnea, bradycardia, and oxygen desaturations) were recorded to ensure the tool does not interfere with infant's feeding ability or does not create any adverse effects. Findings. There was no significant difference in duration, intake volume, rate of transfer between the two monitored sessions, and no occurrence in adverse events. Implications. The findings suggest that the nipple monitoring device may be used for quantitative assessment and intervention planning of oral feeding difficulties in infants.

Background: Caries is a multifactorial degenerative disease, and it is the most common chronic disease during childhood. Few studies have assessed the effects of breastfeeding and bottle feeding on children's dental caries, also taking into account the duration of both options. We investigated whether the infant feeding duration and feeding methods (breast, bottle or both) are risk factors for dental caries in childhood., Methods: Our study included 210 children from 2 to 6 years old and it was carried out in the Department of Pediatric Dentistry of Borgo Cavalli (Treviso, Italy). The average number of decayed, missing, and filled primary tooth surfaces (DMFT) were investigated by analyzing the medical histories. Data collection was conducted from September 2021 to July 2022. Data analysis was performed using the statistical program R (R Foundation for Statistical Computing, Vienna, Austria). First, an analysis was performed to verify the database using a graph. We used the negative Poisson and Binomial count model for the data. Next, the verification of which covariables were significant was performed, finally the conclusions were obtained., Results: By dividing the population according to the type of feeding, we saw that most of the children participating in the study had between 3 and 7 cavities. By analyzing the length of feeding, we saw that the average duration was between 10 and 20 months. Due to the P values, we concluded that the total duration of feeding variable was not significant in explaining the event of interest and, therefore, only the variable type of feeding (artificial and natural) was significant because the P value was below the 5% significance level. Finally, we concluded that natural type breastfeeding increases the average amount of caries by 1.29 times, or 29% more than artificial feeding., Conclusions: Compared to bottle-feeding, breastfeeding increases the risk of caries at an early age; however, there is no correlation between duration and occurrence of caries. Meanwhile, considering health benefits, dental professionals should not discourage breastfeeding; as a matter of fact, promoting breastfeeding has many benefits for infants and mothers, provided that it is associated with proper oral hygiene.

Background: The association between breast milk feeding and dental caries risk in children remains controversial. Moreover, it is unclear whether risk factors for caries differ between breast milk-fed and formula milk-fed infants., Aim: To investigate dental caries in 13- to 18-month-old infants receiving breast milk or formula milk feeding and associated risk factors., Design: One hundred and sixty-six 13- to 18-month-old infants were recruited from a tertiary hospital in Bangkok, Thailand. Information on feeding practices, demographics, and potential risk factors was collected using a caregiver questionnaire. Carious lesions were identified by visual and tactile examination. The Chi-squared test, Mann-Whitney U test, and logistic regression model were used for statistical analysis., Results: The prevalence of caries in breast milk- and formula milk-fed infants was 31.8% and 36.0%, respectively, with no statistically significant difference (p = .579). Among all children, having dental plaque deposition on more than one third of the crown (adjusted OR (aOR): 15.11%; 95% CI: 6.11-37.35) and sleeping while milk feeding (aOR: 2.20%; 95%CI: 1.01-4.77) were associated with dental caries. In subgroup analysis, however, sleeping while milk feeding increased caries risk in the formula milk-fed group only (aOR: 2.95%; 95%CI: 1.07-8.12)., Conclusions: The type of milk feeding was not associated with dental caries, whereas dental plaque and sleeping while milk feeding increased the odds of having dental caries in this population., (© 2021 BSPD, IAPD and John Wiley & Sons Ltd.)

Deleterious oral habits (DOH) have been described as a common finding in pediatric series. Studies have investigated their association with local and systemic health problems. In this study, the association between DOH and asthma was investigated. PubMed, Scopus, Lilacs, Web of Science, Google Scholar, and OpenThesis were accessed to identify observational studies that evaluated the association between DOH (thumb sucking, pacifier use, onychophagia or nail biting, bottle feeding) and asthma in children aged 2-17 years. Information on DOH was obtained from the verbal report of the children's parents. Asthma diagnosis was performed by a physician or using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. We used a random-effects model to pool the results. The odds ratio (OR) was used as measure of association between DOH and asthma. The National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess risk of bias. The GRADE approach was used to assess the quality of evidence. Five studies were included and data from 18,733 children aged 2 to 13 years were analyzed. We found an association between bottle feeding and asthma (OR = 1.25; 95%CI 1.13-1.38; p < 0.001) with moderate level of certainty. Despite the association between pacifier use and asthma (OR = 1.11; 95%CI 1.00-1.24; p = 0.05), the quality of evidence was low. Only one study provided data on nail biting and thumb-sucking, and the individual results showed no association between these habits and asthma. This meta-analysis found an association between bottle feeding, pacifier use, and asthma in children.

Early childhood caries (ECC) remains a public health challenge globally, more so in developing countries. The association between sleep-time feeding practices and ECC remains obscure. The study evaluated this association using Feeding At Sleep Time (FeAST) scale. A case-control study was planned among 627 toddlers, were cases included children with ECC while controls were children without ECC. Three patterns of feeding associated with sleep were recorded: beginning of sleep, during the course of sleep, and early morning hours sleep. Dental caries was scored using International Caries Detection and Assessment System (ICDAS II). The study participants included 302 (48%) cases and 325 (52%) controls. Adjusted odds ratios (AORs) for breastfeeding at the beginning of sleep, during the course of sleep, and early morning hours sleep were 6.7, 6.5, and 3.7, respectively (p = 0.001), on comparing cases versus controls. Similarly, AORs for bottle-feeding at the beginning of sleep, course of sleep, and early morning hours sleep were 5.1, 8.3, and 3.7, respectively (p = 0.001). Addition of sweeteners yielded an AOR = 2.84, while the intake of solids during sleep yielded an AOR of 6.02(p = 0.001). Other feeding modes like sippers, tumblers, etc., had a statistically significant association (p = 0.001). Sleep-time feeding practices increase the risk for ECC in 12- to 36-month-old children., (© 2022 S. Karger AG, Basel.)

Objective: The objective of this review is to determine whether deleterious sucking habits contribute to otitis in newborns, infants, preschool children, and children., Introduction: Otitis is one of the most prevalent diseases in infants. Diverse studies have suggested that deleterious sucking habits, such as pacifier use, bottle-feeding, and finger-sucking, may be risk factors for the development of otitis in young individuals., Inclusion Criteria: This systematic review will include observational studies in which the association between deleterious sucking habits and otitis was assessed in newborns, infants, preschool children, and children. Studies will compare caregiver reporting of sucking habits in this population to those with no deleterious sucking habits or those who exclusively breastfeed. The primary outcome will be the presence of otitis., Methods: The searches will be carried out in six electronic databases, and gray literature will also be screened. A three-step search strategy will be used, with no date or language restrictions. Studies whose full text meets the eligibility criteria will be included in the systematic review. Study screening and selection, critical appraisal, and data extraction will be performed by two independent reviewers. The Grading of Recommendations, Assessment, Development and Evaluation approach will be used to assess the certainty of the evidence. Meta-analysis will be performed if there is relative homogeneity among included studies., Systematic Review Registration Number: PROSPERO CRD42020197162., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 JBI.)

Human milk oligosaccharides (HMOs) are complex sugars that occur naturally in human breast milk and provide many beneficial functions. Most formula products lack HMOs or contain only the most abundant HMO, 2'-fucosyllactose; however, benefits of HMOs come from multiple sugars. We therefore developed a mixture of five HMOs (5HMO-Mix) mimicking the natural concentrations of the top five HMOs (5.75 g/L total, comprising 52% 2'-fucosyllactose, 13% 3-fucosyllactose, 26% lacto- N -tetraose, 4% 3'-sialyllactose, and 5% 6'-sialyllactose) representing the groups of neutral, neutral-fucosylated, and sialylated HMOs. We conducted the first multicenter, randomized, controlled, parallel-group clinical study assessing the safety, tolerability, and effect on growth of formula containing the 5HMO-Mix in healthy infants. We enrolled 341 subjects aged ≤14 days; 225 were randomized into groups fed either with infant formula containing 5HMO-Mix (5HMO-Mix) or infant formula without HMOs (IF) for 4 months, with the others exclusively breastfed. There were no differences in weight, length, or head circumference gain between the two formula groups. The 5HMO-Mix was well tolerated, with 5HMO-Mix and breastfed infants producing softer stools at a higher stool frequency than the control formula group. Adverse events were equivalent in all groups. We conclude that the 5HMO-Mix at 5.75 g/L in infant formula is safe and well tolerated by healthy term infants during the first months of life.

The present study aims to evaluate the effects of an infant formula supplemented with a mixture of prebiotic short and long chain inulin-type oligosaccharides on health outcomes, safety and tolerance, as well as on fecal microbiota composition during the first year of life. In a prospective, multicenter, randomized, double-blind study, n = 160 healthy term infants under 4 months of age were randomized to receive either an infant formula enriched with 0.8 g/dL of Orafti ® Synergy1 or an unsupplemented control formula until the age of 12 months. Growth, fever (>38 °C) and infections were regularly followed up by a pediatrician. Digestive symptoms, stool consistency as well as crying and sleeping patterns were recorded during one week each study month. Fecal microbiota and immunological biomarkers were determined from a subgroup of infants after 2, 6 and 12 months of life. The intention to treat (ITT) population consisted of n = 149 infants. Both formulae were well tolerated. Mean duration of infections was significantly lower in the prebiotic fed infants ( p < 0.05). The prebiotic group showed higher Bifidobacterium counts at month 6 ( p = 0.006), and higher proportions of Bifidobacterium in relation to total bacteria at month 2 and 6 ( p = 0.042 and p = 0.013, respectively). Stools of infants receiving the prebiotic formula were softer ( p < 0.05). Orafti ® Synergy1 tended to beneficially impact total daily amount of crying ( p = 0.0594). Supplementation with inulin-type prebiotic oligosaccharides during the first year of life beneficially modulates the infant gut microbiota towards higher Bifidobacterium levels at the first 6 months of life, and is associated with reduced duration of infections.

Background: The purpose of this systematic review was to analyze the available literature about the influence of breastfeeding in primary and mixed dentition on different types of malocclusions., Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines were used to perform the present review. The following electronic databases were searched: Pubmed, Evidence-Based Medicine Reviews (EBMR), Embase, Cochrane Library, Medline, Web of Science and Ovid., Results: A primary research found a total of 279 articles. Two more papers were also considered from the gray literature. Two hundred sixty-three articles were excluded as they were deemed irrelevant on the basis of: duplicates, title, abstract, methods and/or irrelevant contents. Eighteen papers were selected and included in the qualitative analysis., Conclusions: breastfeeding is a positive factor that seems to reduce the incidence of posterior crossbite, skeletal class II and distoclusion in primary and mixed dentition. A sort of positive relationship between months of breastfeeding and risk reduction seems to exist. More longitudinal research is needed to avoid bias in the results, with data collected prospectively on the months of exclusive breastfeeding, by means of specific questionnaires and successive clinical evaluation of the occlusal condition at the primary dentition, mixed dentition and permanent dentition stages.

Objective: To explore whether the association between bottle-feeding during the first year and childhood obesity at age 6 years is mediated by change in weight-for-age z-score (ΔWAZ) during infancy. Methods: Participants were 1062 mother-child pairs who participated in the Infant Feeding Practices Study II and Year 6 Follow-Up. Mothers completed 1 prenatal questionnaire, 10 postpartum questionnaires during the first year, and 1 follow-up questionnaire at 6 years. Child weights were reported by mothers and used to determine ΔWAZ from birth to later infancy. Causal mediation analysis was used to determine the average direct effect of bottle-feeding on obesity at age 6 years and the average causal mediation effect of bottle-feeding through ΔWAZ. Results: Infants who experienced rapid increases in bottle-feeding frequency during the first 6 months had significantly greater ΔWAZ compared with infants who had consistently low bottle-feeding frequency until 12 months of age [ β  = 0.45, 95% confidence interval (CI) 0.11-0.80]. Significant predictors of obesity at age 6 years were larger birth weight [adjusted odds ratio (AOR) = 4.27, 95% CI 2.42-7.64] and larger ΔWAZ (AOR = 1.59, 95% CI 1.29-1.98). An indirect effect of bottle-feeding, mediated via ΔWAZ, accounted for 59% of the total effect of bottle-feeding on obesity at age 6 years. Conclusions: Rapid increases in bottle use during the first 6 months postpartum predicted greater risk for obesity at age 6 years via an indirect mediation effect of larger ΔWAZ from birth to later infancy.

The human microbiome plays a number of critical roles in host physiology. Evidence from longitudinal cohort studies and animal models strongly supports the theory that maldevelopment of the microbiome in early life can programme later-life disease. The early-life microbiome develops in a clear stepwise manner over the first 3 years of life. During this highly dynamic time, insults such as antibiotic use and formula feeding can adversely affect the composition and temporal development of the microbiome. Such experiences predispose infants for the development of chronic health conditions later in life. This review highlights key factors that disrupt the early-life microbiome and highlights major non-communicable diseases which are underpinned by early-life dysbiosis.

Malocclusions are changes in the development of craniofacial structures of high prevalence. Associated risk factors are diverse and nutritional and non-nutritional suction habits are the most reported. The aim of this study was to estimate the prevalence of malocclusions in the mixed dentition and to study possible association with practices of breastfeeding and suction habits among Brazilian schoolchildren. A cross-sectional study involving a sample of 664 6-year-old children and their families was carried out. Data collection was done through interviews with mothers in the homes and oral examinations of children in schools. Multivariate analyses were performed using the Poisson regression with a robust estimator. The prevalence of overjet over 4 mm was 21.1% and of posterior crossbite was 12.2%; 91.9% of the children were breastfed, 79.0% used a nursing bottle and 49.4% used a pacifier. Significant and independent associations were observed between father's unemployment, private school, interruption of breastfeeding before the fourth month and pacifier use with certain malocclusions. High rates of malocclusion were found in the studied sample. Socioeconomic conditions, breastfeeding practices and suction habits were shown to be statistically associated with their occurrence.

Background: For preterm infants, human milk (HM) has to be fortified to cover their enhanced nutritional requirements and establish adequate growth. Most HM fortifiers are based on bovine protein sources (BMF). An HM fortifier based on human protein sources (HMF) has become available in the last few years. The aim of this study is to investigate the impact of an HMF versus BMF on growth in extremely low birth weight (ELBW, <1000 g) infants., Methods: This was a retrospective, controlled, multicenter cohort study in infants with a birthweight below 1000 g. The HMF group received an exclusive HM diet up to 32+0 weeks of gestation and was changed to BMF afterwards. The BMF group received HM+BMF from fortifier introduction up to 37+0 weeks., Results: 192 extremely low birth weight (ELBW)-infants were included (HMF n = 96, BMF n = 96) in the study. After the introduction of fortification, growth velocity up to 32+0 weeks was significantly lower in the HMF group (16.5 g/kg/day) in comparison to the BMF group (18.9 g/kg/day, p = 0.009) whereas all other growth parameters did not differ from birth up to 37+0 weeks. Necrotizing enterocolitis (NEC) incidence was 10% in the HMF and 8% in the BMF group., Conclusion: Results from this study do not support the superiority of HFM over BMF in ELBW infants., Competing Interests: The authors declare no conflict of interest.

Allergy risk has become a significant public health issue with increasing prevalence. Exclusive breastfeeding is recommended for the first six months of life, but this recommendation is poorly adhered to in many parts of the world, including the Middle-East region, putting infants at risk of developing allergic sensitization and disorders. When breastfeeding is not possible or not adequate, a partially hydrolyzed whey formula (pHF-W) has shown proven benefits of preventing allergy, mainly atopic eczema, in children with a genetic risk. Therefore, besides stimulating breastfeeding, early identification of infants at risk for developing atopic disease and replacing commonly used formula based on intact cow milk protein (CMP) with a clinically proven pHF-W formula is of paramount importance for allergy prevention. If the child is affected by cow's milk protein allergy (CMPA), expert guidelines recommend extensively hydrolyzed formula (eHF), or an amino acid formula (AAF) in case of severe symptoms. The Middle-East region has a unique practice of utilizing pHF-W as a step-down between eHF or AAF and intact CMP, which could be of benefit. The region is very heterogeneous with different levels of clinical practice, and as allergic disorders may be seen by healthcare professionals of different specialties with different levels of expertise, there is a great variability in preventive and treatment approaches within the region itself. During a consensus meeting, a new approach was discussed and unanimously approved by all participants, introducing the use of pHF-W in the therapeutic management of CMPA. This novel approach could be of worldwide benefit., Competing Interests: Yvan Vandenplas has participated as a clinical investigator, and/or advisory board member, and/or consultant, and/or speaker for Abbott Nutrition, Astel Medica, Danone, Nestle Health Science, Nestle Nutrition Institute, Nutricia, Mead Johnson Nutrition, United Pharmaceuticals, and Wyeth. None of the other authors have a conflict of interest.

Background Tube-assisted feeding in infancy is common in patients with single-ventricle physiology ( SVP ). Postnatal brain development is delayed, and injury is common, in patients with SVP . The role of brain findings in feeding outcomes remains unclear. We sought to determine the association between neonatal perioperative brain injury and postnatal brain maturation with feeding-tube dependency in patients with SVP at neonatal discharge and just before the stage-2 palliation. Methods and Results We evaluated a cohort of 48 term neonates with SVP who underwent pre- and postoperative brain magnetic resonance imaging. Perioperative brain injury and microstructural brain development were measured with diffusion tensor imaging including fractional anisotropy in white matter and apparent diffusion coefficient in gray matter. The primary outcome was defined as being 100% orally fed (binary). Of the patients 79% (38/48) were tube fed at hospital discharge, and 27% (12/45) were tube fed before stage-2 palliation. Perioperative brain injury did not differ by group. Orally fed patients had a faster rate of decrease in apparent diffusion coefficient (3%, 95% CI 1.7% to 4.6%, P<0.001) at discharge and a faster rate of increase in fractional anisotropy (1.4%, 95% CI 0.6% to 2.2%, P=0.001) at the time of stage-2 palliation compared with tube-fed patients, denoting more robust brain development. Conclusions Slower rate of postnatal brain maturation but not perioperative brain injury is associated with feeding modality in infancy. These results support the importance of brain health in optimizing feeding outcomes in patients with SVP .

Background: The current literature does not provide accurate information about the association between use of artificial nipples and sucking patterns in infants., Aims: We aimed to investigate whether pacifier use and/or bottle-feeding were associated with nutritive sucking (NS) and non-nutritive sucking (NNS) patterns., Study Design: Cross-sectional study., Subjects: 429 full-term infants/mothers., Outcome Measures: Data were collected through a questionnaire and observations of NS during breastfeeding and NNS (finger sucking). Multivariate logistic regression was used to analyze the adjusted associations between artificial nipple use and between NS and NNS changes., Results: There were higher frequencies of changes in the NNS and NS patterns in the group that used artificial nipples. Regarding the type of artificial nipple, pacifier use had a greater influence on changes in the NNS pattern whereas the use of a baby bottle presented a greater number of associations with changes in the NS pattern., Conclusion: The findings suggest that the use of artificial nipples may be associated with changes in the sucking patterns of infants, demonstrating the possible existence of nipple confusion and its effect on breastfeeding., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objective: The aim of the present study is to investigate the duration of breastfeeding in relation to various parafunctional oral habits in children with anxiety disorders., Materials and Methods: The study includes 195 children and adolescents with anxiety disorders and age- and gender-matched 255 healthy control subjects. Diagnoses were made with semistructured interview (K-SADS). Information about breastfeeding and parafunctional oral habits was investigated via a questionnaire prepared for the study., Results: The mean age was 11.50 ± 2.50 years for clinical group and 11.27 ± 2.33 years for controls. Fifty-four percent of the clinical group and 56% of the control group were female subjects. Duration of exclusive (4.72 ± 2.86, 5.55 ± 2.36; p = 0.002) and total breastfeeding (12.38 ± 10.32, 15.89 ± 9.09; p < 0.001) was significantly lower and duration of bottle-feeding (22.30 ± 19.54, 16.64 ± 12.79; p = 0.005) was higher than controls in the clinical group. Duration of exclusive breastfeeding was significantly correlated with duration of bottle-feeding (r = -0.263, p < 0.001) and duration of pacifier use (r = -0.249, p = 0.001). Multiple regression analysis showed that duration of exclusive breastfeeding (β = 0.88, p = 0.006) and bottle-feeding (β = 1.02, p = 0.005), as well as various oral habits, was associated with diagnosis of an anxiety disorder., Conclusion: Nutrition methods in early years of life may result in long-term consequences regarding anxiety disorders for children. Clinicians should encourage parents for a shorter duration of bottle-feeding and a longer duration of exclusive breastfeeding.

Objective: The study objective was to investigate factors associated with resilience to rapid weight gain (RWG) among predominantly bottle-fed infants., Methods: Data came from 1,353 mothers who participated in the Infant Feeding Practices Study 2. Mothers completed a prenatal questionnaire and monthly surveys of infant feeding and growth between birth and 12 months. Infants were classified as resilient if they were predominantly bottle fed but did not exhibit RWG between birth and the latter half of infancy (≥ +0.67 change in weight-for-age z score)., Results: Thirty-five percent of the sample (n = 467) was predominantly bottle fed but did not exhibit RWG ("Resilient"), 17% (n = 228) was predominantly bottle fed and exhibited RWG ("Not Resilient"), and 49% (n = 658) was not predominantly bottle fed ("Low Risk"). Significant predictors of resilience to RWG were greater gestational age (P = 0.042) and weight (P < 0.001) at birth, lower frequency of adding cereal to the bottle (P = 0.022), lower frequency of infant-led bottle-emptying (P = 0.047), and greater frequency of maternal encouragement of bottle-emptying (P = 0.002)., Conclusions: Associations between bottle-feeding and RWG may be moderated by infant characteristics and maternal feeding practices. The present study highlighted several characteristics of predominantly bottle-fed infants who were resilient to RWG, but further research is needed to identify a broader array of key targets for future intervention efforts., (© 2018 The Obesity Society.)

Early nutrition may have long-lasting metabolic impacts in adulthood. Even though breast milk is the gold standard, most infants are at least partly formula-fed. Despite obvious improvements, infant formulas remain perfectible to reduce the gap between breastfed and formula-fed infants. Improvements such as reducing the protein content, modulating the lipid matrix and adding prebiotics, probiotics and synbiotics, are discussed regarding metabolic health. Numerous questions remain to be answered on how impacting the infant formula composition may modulate the host metabolism and exert long-term benefits. Interactions between early nutrition (composition of human milk and infant formula) and the gut microbiota profile, as well as mechanisms connecting gut microbiota to metabolic health, are highlighted. Gut microbiota stands as a key actor in the nutritional programming but additional well-designed longitudinal human studies are needed.

Objective: To assess the efficacy of a theory-based behavioural intervention to prevent rapid weight gain in formula milk-fed infants., Design: In this single (assessor) blind, randomised controlled trial, 669 healthy full-term infants receiving formula milk within 14 weeks of birth were individually randomised to intervention (n=340) or attention-matched control (n=329) groups. The intervention aimed to reduce formula milk intakes, and promote responsive feeding and growth monitoring to prevent rapid weight gain (≥+0.67 SD scores (SDS)). It was delivered to mothers by trained facilitators up to infant age 6 months through three face-to-face contacts, two telephone contacts and written materials., Results: Retention was 93% (622) at 6 months, 88% (586) at 12 months and 94% attended ≥4/5 sessions. The intervention strengthened maternal attitudes to following infant feeding recommendations, reduced reported milk intakes at ages 3 (-14%; intervention vs control infants), 4 (-12%), 5 (-9%) and 6 (-7%) months, slowed initial infant weight gain from baseline to 6 months (mean change 0.32 vs 0.42 SDS, baseline-adjusted difference (intervention vs control) -0.08 (95% CI -0.17 to -0.004) SDS), but had no effect on the primary outcome of weight gain to 12 months (baseline-adjusted difference -0.04 (-0.17, 0.10) SDS). By 12 months, 40.3% of infants in the intervention group and 45.9% in the control group showed rapid weight gain (OR 0.84, 95% CI 0.59 to 1.17)., Conclusions: Despite reducing milk intakes and initial weight gain, the intervention did not alter the high prevalence of rapid weight gain to age 12 months suggesting the need for sustained intervention., Trial Registration Number: ISRCTN20814693., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objective: To investigate the association between pacifier use and bottle-feeding and unfavorable behaviors during breastfeeding., Method: A cross-sectional study was conducted with 427 babies/mothers. Socio-demographic, perinatal data, and information about the use of artificial nipples (pacifier and/or bottle) were collected through a questionnaire. The breastfeeding aspects regarding position, affectivity, sucking behavior, baby responses, and breast anatomy were evaluated through observation during breastfeeding. The chi-squared test and the multiple linear regression analysis were used to investigate the association between the variables., Results: The aspects of breastfeeding that showed higher percentages of the category "poor" were sucking behavior (22.5%) and position (22.2%). The group of infants who used pacifiers and/or bottle showed higher percentages in the poor and fair categories when compared with the good category for all five breastfeeding aspects evaluated (p<0.001). The linear regression analysis revealed that the increase in the number of unfavorable behaviors regarding position, affectivity, sucking behavior, and baby responses were independently associated with both pacifier and bottle use (β positive, p<0.05), while breast anatomy was independently associated only with bottle use., Conclusion: The findings suggest that the use of pacifiers and/or bottle-feeding may be associated with unfavorable behaviors during breastfeeding, especially the use of bottle-feeding., (Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Nutritionally, the first 1,000 days of an infant's life - from conception to two years - has been identified as a highly influential period, during which lasting health can be achieved. Significant evidence links patterns of infant feeding to both short and long-term health outcomes, many of which can be prevented through nutritional modifications. Recommended globally, breastfeeding is recognised as the gold standard of infant nutrition; providing key nutrients to achieve optimal health, growth and development, and conferring immunologic protective effects against disease. Nevertheless, infant formulas are often the sole source of nutrition for many infants during the first stage of life. Producers of infant formula strive to supply high quality, healthy, safe alternatives to breast milk with a comparable balance of nutrients to human milk imitating its composition and functional performance measures. The concept of 'nutritional programming', and the theory that exposure to specific conditions, can predispose an individual's health status in later life has become an accepted dictum, and has sparked important nutritional research prospects. This review explores the impact of early life nutrition, specifically, how different feeding methods affect health outcomes.

The etiology and pathogenesis of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome are unclear. We performed a case-control study to evaluate potential environmental or lifestyle factors associated with PFAPA morbidity. We enrolled 119 patients with PFAPA syndrome who had undergone tonsillectomy in Oulu University Hospital between 1987 and 2007. We recruited 230 controls, matched for sex, birth date, and place from the database of the Population Register Center of Finland. All the patients and controls completed a questionnaire regarding exposure to environmental triggers during early childhood. Maternal smoking was more common among PFAPA syndrome patients than controls (23 vs. 14%; P = 0.005). PFAPA patients had lower breastfeeding rates than controls (94 vs. 99%; P = 0.006). No other environmental factors were associated with PFAPA syndrome, except having an aquarium at home (P = 0.007). The patient group also used natural or herbal medicines more often than the controls (P = 0.01)., Conclusion: Maternal smoking and lack of breastfeeding, known risk factors for common childhood infections, were more common in patients with PFAPA syndrome than in matched controls. Environmental factors may be important in the pathogenesis of PFAPA syndrome and should be evaluated in future studies. What is Known: • The pathogenesis and genetics of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome remain unsolved. • PFAPA syndrome has been shown to cluster in families. What is New: • Maternal smoking and lack of breastfeeding are more common in patients with PFAPA syndrome than in the controls. • Environmental risk factors may be important in the pathogenesis of the syndrome.

Purpose: The purpose of this study was to determine if brief video-recorded patient simulation training increased students' ability to assess feeding skills in preterm infants., Method: Baccalaureate-level nursing students (N = 52) and graduate-level speech-language pathology students (N = 42) were randomized to 1 of 2 groups: didactic training (N = 51) or didactic training plus video simulation (N = 43). Outcome measures included knowledge test scores, calculated clinical judgment scores, and clinical marker documentation accuracy., Results: Students' knowledge increased as the result of training, without differences in test scores between the 2 types of training. Students who received video simulation training interpreted simulated feeding behaviors of preterm infants more accurately than students who received didactic training. Infant distress signs were also documented with higher accuracy for students who received video simulation training. After training and regardless of method, participants correctly attributed distress behaviors during bottle-feeding to increased risk for feeding difficulty., Conclusions: In the current educational environment, training opportunities with high-risk preterm infants are constrained by access to health care settings specializing in care for this population and availability of clinical supervisors with expertise in this area of practice. Patient simulators are expensive; however, video simulation offers inexpensive opportunities for students to effectively gain knowledge and skills for assessing feeding in preterm infants. With video simulation, students effectively apply principles of preterm infant feeding to cases and practice critical thinking skills before entering related clinical practicum placements.

Milk powder and gluten are common components in Swedish infants' diets. Whereas large intakes of gluten early in life increases the risk of celiac disease in genetically at-risk Swedish children, no study has yet evaluated if intake of milk powder by 2 years of age is associated with celiac disease. A 1-to-3 nested case-control study, comprised of 207 celiac disease children and 621 controls matched for sex, birth year, and HLA genotype, was performed on a birth cohort of HLA-DR3-DQ2 and/or DR4-DQ8-positive children. Subjects were screened annually for celiac disease using tissue transglutaminase autoantibodies (tTGA). Three-day food records estimated the mean intake of milk powder at ages 6 months, 9 months, 12 months, 18 months, and 24 months. Conditional logistic regression calculated odds ratios (OR) at last intake prior to seroconversion of tTGA positivity, and for each time-point respectively and adjusted for having a first-degree relative with celiac disease and gluten intake. Intake of milk powder prior to seroconversion of tTGA positivity was not associated with celiac disease (OR = 1.00; 95% CI = 0.99, 1.03; p = 0.763). In conclusion, intake of milk powder in early childhood is not associated with celiac disease in genetically susceptible children.

Mexican and international authorities provide guidelines for milk and beverage consumption for young children. This study classifies beverages as appropriate or inappropriate by age (0-5.9, 6-11.9, and 12-23.9 months) and details consumption patterns, amounts consumed, and the associated socio-demographic characteristics. Analysis of the Mexican National Nutrition and Health Survey (ENSANUT 2012) was conducted ( n = 949). Among 0-5.9 month olds, 66.7% consumed either breast milk, infant formula, or a combination with no other beverages, whereas 29.3% consumed breast milk and/or infant formula with water (mean = 58 g/day) and/or other beverages (mean = 115 g/day), such as 100% fruit juice, milk, and sugar-sweetened beverages (SSBs). For infants 6-11.9 months, appropriate beverages include breast milk, infant formula, and water; only 40.2% met these recommendations. Many 6-11.9 month olds consumed age-inappropriate beverages, including milk (31%) and SSBs (35%). After 12 months of age, appropriate beverages include water, milk, and a limited amount of 100% fruit juice and SSBs; 32.4% complied fully, 18.3% consumed appropriate and inappropriate beverages, and 49.3% consumed only inappropriate beverages. Among 12-23.9 month olds, 58% consumed milk, 18% juice, and 42% water while 63% consumed SSBs. Many infants and young children are not compliant with Mexican and international breastfeeding and complementary feeding guidelines for beverages. Communication and guidance about age-appropriate beverages should be improved., Competing Interests: M.C.A., L.R.F., and A.L.E. are employed by the Nestlé Research Center, sponsors of these analyses. K.C.R. is employed by Nestlé Nutrition in Florham Park, NJ, USA. S.V.-C. has a joint appointment at Hospital Infantil de Mexico, Gastroenterology and Nutrition, and Nestlé Infant Nutrition in Mexico City, Mexico.

Bronchopulmonary dysplasia (BPD) is the most common complication after preterm birth. Pasteurized donor human milk (DHM) has increasingly become the standard of care for very preterm infants over the use of preterm formula (PF) if the mother's own milk (MOM) is unavailable. Studies have reported beneficial effects of DHM on BPD. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies on the effects of DHM on BPD and other respiratory outcomes. Eighteen studies met the inclusion criteria. Meta-analysis of RCTs could not demonstrate that supplementation of MOM with DHM reduced BPD when compared to PF (three studies, risk ratio (RR) 0.89, 95% confidence interval (CI) 0.60-1.32). However, meta-analysis of observational studies showed that DHM supplementation reduced BPD (8 studies, RR 0.78, 95% CI 0.67-0.90). An exclusive human milk diet reduced the risk of BPD, compared to a diet with PF and/or bovine milk-based fortifier (three studies, RR 0.80, 95% CI 0.68-0.95). Feeding raw MOM, compared to feeding pasteurized MOM, protected against BPD (two studies, RR 0.77, 95% CI 0.62-0.96). In conclusion, our data suggest that DHM protects against BPD in very preterm infants., Competing Interests: The authors declare no conflict of interest.

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., (© 2018 S. Karger AG, Basel.)

The method and technique of feeding a young child affect the shape of the maxillofacial complex. Breastfeeding is the recommended method of feeding in the first six months of life. It is encouraged to continue natural feeding in later months, simultaneously developing other food extraction techniques. The correct formation of the stomatognathic system is a result of the correct organization of the motor patterns during feeding.

Objectives: To examine levels of bacterial contamination in formula feeding bottles in Sidoarjo, East Java, and to assess the preparation practices that may have been responsible., Methods: A cross-sectional study was conducted among 92 randomly selected households with children under the age of two who were bottle-fed formula. In each household, we carried out video observation of mothers/caregivers preparing bottles, and examined samples of formula for coliform bacteria and Escherichia coli (E. coli). In-depth interviews were conducted with a subsample of 20 mothers., Results: A total of 88% of the formula feeds were contaminated with total coliforms at a level >10 MPN/ml, and 45% contained E. coli. These feeds were defined as 'unfit for human consumption'. In the video observations, none of the mothers complied with all five WHO-recommended measures of hygienic formula feed preparation. Only two mothers washed their hands with soap prior to formula preparation. Most mothers also failed to clean or sterilise the bottle and clean the preparation area. In-depth interviews confirmed that such suboptimal hygiene practices were common., Conclusion: The high levels of contamination found highlight that bottles are an important faecal-oral exposure pathway resulting from poor hygiene practices during bottle preparation., (© 2017 John Wiley & Sons Ltd.)

Background: Growth is an essential outcome measure for evaluating the safety of infant formulas (IF). We investigated the effects of consumption of IF supplemented with prebiotics (fructooligosaccharides, FOS, and galactooligosaccharides, GOS) compared with synbiotics (FOS/GOS and Lactobacillus paracasei ssp. paracasei strain F19) on the growth of healthy infants., Methods: 182 full-term infants who were weaned completely from breast milk to IF at 28 d of age were randomly assigned to receive prebiotic- or synbiotic-supplemented, otherwise identical, IF until 6 mo of age (intervention period)., Results: A total of 146 (80%) infants were included in the intention-to-treat analysis at 6 mo. Anthropometric parameters were similar in the two groups during the intervention and follow-up period until 12 mo of age. Compared with the prebiotic group, a significant reduction in the cumulative incidence of lower respiratory tract infections was found in the synbiotic group; however, the confidence interval of the estimate was wide, resulting in uncertainty., Conclusion: The lack of a significant difference between the formula-fed groups in growth, or the occurrence of serious adverse events, supports the safety of using IF supplemented with synbiotics. Further studies are needed to evaluate the effects of such formula on lower-respiratory tract infections.

Background: Preparation for hospital discharge after birth became a global concern when hospitals in many developing countries began implementing shorter lengths of stay for uncomplicated deliveries. A mother's perceived readiness for hospital discharge may be influenced by many factors that can ultimately shape postdischarge outcomes., Aims: The purpose of this study was to explore the antepartum, intrapartum, and postpartum predictors of discharge readiness, including nursing educational practices that are predictive of postpartum mothers' perceptions of readiness for hospital discharge., Methods: The Adaptation to Transitions conceptual framework guided the descriptive correlational study design and measures. A purposive sample of 185 English- and Spanish-speaking postpartum mothers who experienced an uneventful vaginal or cesarean birth of a healthy infant completed demographic, quality of discharge teaching, and readiness for hospital discharge questionnaires prior to discharge., Results: Mothers with three or more children, delivery mode, bottle-feeding, the delivery of education, and the difference between educational content received and needed, were significant predictors that accounted for 42% of the variance in readiness for hospital discharge (R 2 = 0.42, F [10,174] = 14.52, p < .001). Nurses' skill in teaching and educational content received were significant predictors even with parity, feeding, and delivery mode in the model., Linking Evidence to Action: The relationship between quality of discharge teaching and discharge readiness provides evidence of the critical role nurses have in the discharge preparation process. Nurse education programs and evidence-based guidelines should be designed to enhance patient education focused on the adequacy and delivery of teaching content., (© 2017 Sigma Theta Tau International.)

Objective: To describe patterns of bottle-feeding across the first year postpartum and explore whether bottle-feeding trajectories are differentially associated with infant weight gain., Method: Data came from 1291 mothers who participated in the Infant Feeding Practices Study 2. Mothers completed a prenatal questionnaire and monthly surveys of infant feeding and growth between birth and 12 months. Group-based trajectory mixture modeling was used to describe developmental trajectories of bottle-feeding intensities across the first year. Growth curve modeling was used to explore associations between bottle-feeding intensity trajectory group membership and weight-for-age z-score (WAZ) trajectories from birth to 12 months., Results: Four qualitatively distinct trajectories of bottle-feeding were identified: (1) High-Stable: ∼100% of feeds from bottles across infancy; (2) Rapid-Increase: <30% of feeds from bottles during the neonatal assessment, increasing to ∼100% by 6 months; (3) Gradual-Increase: <10% of feeds from bottles during the neonatal assessment, gradually increasing to ∼100% by 12 months; and (4) Low-Stable: <5% of feeds from bottles across the majority of infancy. Bottle-feeding groups had significantly different WAZ trajectories across infancy; by 12 months, the High-Stable and Rapid-Increase groups had significantly higher WAZs compared with the Gradual-Increase and Low-Stable groups (p < .001). The association between bottle-feeding group membership and WAZ trajectories was not confounded by sociodemographic characteristics or the extent to which infants received breast milk., Conclusion: High-intensity bottle use during early infancy may place infants at higher risk for excess weight gain. Supports and policies that help mothers delay high-intensity bottle use until later infancy are warranted.

Objective: To assess the effects of breast-feeding duration, bottle-feeding duration and oral habits on the occlusal characteristics of primary dentition in 3-6-year-old children in Beijing., Methods: This cross sectional study was conducted via an examination of the occlusal characteristics of 734 children combined with a questionnaire completed by their parents/guardians. The examination was performed by a single, previously calibrated examiner and the following variables were evaluated: presence or absence of deep overbite, open bite, anterior cross bite, posterior cross bite, deep overjet, terminal plane relationship of the second primary molar, primary canine relationship, crowding and spacing. Univariate analysis and multiple Logistic regressions were applied to analyze the associations., Results: It was found that a short duration of breast-feeding (never or ≤6 months) was directly associated with posterior cross bite (OR=3.13, 95%CI=1.11-8.82, P=0.031) and no maxillary space (OR=1.63, 95%CI=1.23-2.98, P=0.038). In children breast-fed for ≤6 months, the probability of developing pacifier-sucking habits was 4 times that for those breast-fed for >6 months (OR=4.21, 95%CI=1.85-9.60, P=0.000 2). The children who were bottle-fed for over 18 months had a 1.45-fold higher risk of nonmesial step occlusion and a 1.43-fold higher risk of class II canine relationship compared with those who were bottle-fed for 6-18 months. Non-nutritive sucking habits were also found to affect occlusion: a prolonged digit-sucking habit increased the probability of an anterior open bite, while a pacifier-sucking habit was associated with excessive overjet and absence of lower arch developmental space. Tongue-thrust habit was associated with anterior open bite (OR=4.21, 95%CI=1.85-9.60, P=0.000 2) and posterior cross bite (OR=7.24, 95%CI=1.30-40.13, P=0.024). Lower lip sucking habit was associated with deep overjet and had a negative association with class III canine relationship. Unilateral chewing was associated with spacing in mandibular (OR=1.57, 95%CI=1.03-2.41, P=0.037). Mouth breathing was associated with chronic rhinitis and adenoidal hypertrophy and had an association with spacing in maxillary. The chi-square test did not indicate a statistically significant association between upper lip sucking habit and any occlusal characteristics., Conclusion: Breast-feeding duration was shown to be associated with the prevalence of posterior crossbite, or no maxillary space in the deciduous dentition and development of a pacifier-sucking habit. Children who had a longer duration of bottle-feeding were more likely to develop class II canine relationship. Children who had an oral habit were more likely to develop abnormal occlusal characteristics.

Background: Strong recommendations have been made for exclusive breastfeeding of infants for the first 6 months of life, with continuation throughout the first year. In an attempt to optimize support for breastfeeding, particular barriers in populations with decreased rates need to be analyzed., Objective: This study aimed to determine if participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food voucher program, involvement of the infant's father, involvement of the adolescent mother's parents or other caregivers, and participation in early skin-to-skin contact after birth are associated with the decision to breastfeed or bottle feed among this adolescent population., Methods: A retrospective chart review of 457 adolescent patients who delivered January 2010 through May 2013 at the University of Louisville Hospital was conducted. Nursing documentation was used to determine the patient's intention to breastfeed or bottle feed, participation in WIC, involvement of the infant's father, involvement of the patient's parents, and participation in early skin-to-skin contact after delivery. These factors were compared using Fisher exact test., Results: Three hundred one adolescents reported a plan to breastfeed (65.9%) and 156 reported a plan to bottle feed (34.1%) when questioned pre-delivery. There was no significant difference between the groups with respect to WIC participation or involvement of the infant's father. The bottle-feeding group had a significantly higher percentage who reported parental involvement (80.1% vs 67.8%, P = .0059). The breastfeeding group had a significantly higher percentage who participated in early skin-to-skin contact after birth (74.5% vs 58.1%, P = .0064)., Conclusion: Involvement of the adolescent mothers' parents or caregivers was associated with the decision to bottle feed. Participation in early skin-to-skin contact after birth was associated with the decision to breastfeed.

Since the European Commission prohibited the use of bisphenol A in the production of polycarbonate (PC) baby bottles, many other materials have replaced PC for the manufacture of this type of food contact materials. In the present study, the potential migration risks associated with these alternative materials were investigated. First, all substances were evaluated for endocrine disruptive (ED) activity by using different existing lists of (suspected) ED chemicals. Next, the potential non-ED risks were assessed. A distinction was made between migrants listed in Annex I of European Regulation 10/2011 and the unlisted substances (e.g. non-intentionally added substances). For the listed substances, concentrations in the migration solutions were compared to their respective specific migration limits (SML) (when applicable). Migration of all substances was shown to be below their SML. The unlisted substances were evaluated using toxicological information from previous evaluations, or if not available, by applying the Threshold of Toxicological Concern (TTC) approach. In case the estimated exposure to the unlisted substance exceeded the human exposure TTC value, a more indepth risk assessment was performed. Based on the results of both parts of the study, four baby bottles were considered of high concern because of the potential toxicity of migrating compounds., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

After the prohibition of bisphenol-A-containing polycarbonate baby bottles in the European Union (EU), alternative materials, such as polypropylene, polyethersulphone, Tritan™ copolyester, etc., have appeared on the market. Based on an initial screening and in vitro toxicity assessment, the most toxic migrating compounds were selected to be monitored and quantified using validated GC- and LC-QqQ-MS methods. The effect of several 'real-life-use conditions', such as microwave, sterilisation and dishwasher, on the migration of different contaminants was evaluated by means of duration tests. These results were compared with a reference treatment (filling five times with pre-heated simulant at 40°C) and with the legal EU 'repetitive-use conditions' (three migrations, 2 h at 70°C). Analysis of the third migration step of the EU repetitive-use conditions (which has to comply with the EU legislative migration limits) showed that several non-authorised compounds were observed in some baby bottles exceeding 10 µg kg(-1). However, all authorised compounds were detected well below their respective specific migration limits (SMLs). The reference experiment confirmed the migration of some of the compounds previously detected in the EU repetitive-use experiment, though at lower concentrations. Analysis of extracts from the microwave and dishwasher experiments showed a reduction in the migration during the duration tests. In general, the concentrations found were low and comparable with the reference experiment. Similar observations were made for the two sterilisation types: steam and cooking sterilisation. However, steam sterilisation seems to be more recommended for daily use of baby bottles, since it resulted in a lower release of substances afterwards. Repeated use of baby bottles under 'real-life' conditions showed no increase in the migration of investigated compounds and, after some time, the migration of these compounds even became negligible.

Purpose: Check if the type of nozzle, orthodontic or conventional, of pacifier and bottle have any influence on the changes found in the stomatognathic system caused by the maintenance of the sucking habit. Research Strategies: Through a systematic literature review with meta-analysis, performed from the databases Lilacs, Medline and Embase and Scholar Google, with the following key words in Portuguese and English: "malocclusion" + "Pacifiers "; "Malocclusion" + "Bottle Feeding"; "Malocclusion" + "Bottle feeding" beyond words "Orthodontic Beak" + "Conventional Beak"., Selection Criteria: We included studies that presented in their methods to compare groups who used pacifiers and/or bottle with conventional nozzle with groups using orthodontic nipple without temporal delimitation., Data Analysis: The analysis of the article in its entirety was performed systematically, ordering the relevant results in the following categories: objective, method-case studies and evaluation, results, and conclusion., Results: Found 1,041 jobs, from the period 1969 to 2013, 848 jobs were excluded based on the exclusion criteria and another 174 that were repetitions. A total of 19 articles were read in full of which 4 articles met the proposed inclusion criteria, and three studies were included in the meta-analysis. These results show that there are no significant differences between the orthodontic and conventional nozzles on the implications of the stomatognathic system., Conclusion: There is no way to conclude that there are differences as to the consequences to the stomatognathic system caused by conventional nozzles and orthodontic pacifier/bottle.

Background: The relation between infant feeding and growth has been extensively evaluated, but studies examining sex differences in the influence of infant milk feeding on growth are limited., Objective: We examined the interaction of infant feeding and sex in relation to infant growth and compared growth trajectories in breastfed and formula-fed boys and girls., Design: In 932 infants in a Singapore mother-offspring cohort, feeding practices in the first 6 mo were classified into the breastfeeding group (BF), mixed feeding group (MF), and formula feeding group (FF). Infant weight and length were measured and converted to WHO standards for weight-for-age z scores (WAZs) and length-for-age z scores (LAZs). Differences in WAZ and LAZ from birth to 6 mo, 6 to 12 mo, and 12 to 24 mo of age were calculated. Three-way interactions were examined between feeding mode, sex, and age intervals for WAZ and LAZ changes, with adjustment for confounders., Results: The interaction between feeding mode, sex, and age intervals was significant for LAZ changes (P = 0.003) but not WAZ changes (P = 0.103) after adjustment for potential confounders. Compared with BF girls, BF boys showed similar LAZ gain (+0.28 compared with +0.39, P = 0.544) from 0 to 6 mo of age but greater LAZ gain from 6 to 12 mo of age (+0.39 compared with -0.10, P = 0.008). From 0 to 6 mo of age, FF boys and girls showed greater LAZ gains than their BF counterparts; from 6 to 12 mo of age, FF girls showed higher LAZ gain (+0.25 compared with -0.10, P = 0.031) than BF girls, which was not seen in boys., Conclusions: During infancy, there is a sexually dimorphic growth response to the mode of infant milk feeding, raising questions about whether formula feeding ought to remain sex neutral. However, further investigations on sex-specific feeding and infant growth are warranted before a conclusive message can be drawn based on our current findings. This trial was registered at www.clinicaltrials.gov as NCT01174875., (© 2016 American Society for Nutrition.)

This cohort study was conducted in Khon Kaen, Thailand, to test the hypothesis that a longer breastfeeding duration increases the risk for dental caries in primary teeth. We collected information on infant feeding practices and potential confounders using a structured questionnaire to interview mothers or caregivers during the second trimester of pregnancy and after birth at 21 days and at 3, 12, 18, 24, and 36 months. Regardless of other liquids and foods, full breastfeeding was defined as feeding breast milk but not formula, while any breastfeeding was feeding breast milk with or without formula. Two calibrated dentists measured dental caries when the children were 3-4 years of age using the decayed, missing, and filled surfaces (dmfs) index following the World Health Organization criteria. Negative binomial regression with a generalized linear model was used to estimate relative risks (RRs) and 95% confidence intervals (CIs) using dmfs as an outcome. Log-binomial regression was performed to model the caries prevalence. Of 556 children, 88.1% had dental caries with a mean dmfs of 14.2. Full breastfeeding for 6-11 months was significantly associated with a lower dmfs (adjusted RR 0.77, 95% CI 0.63, 0.93) and a lower caries prevalence (adjusted RR 0.45, 95% CI 0.22, 0.90). The frequency of sleeping while breast- or bottle-feeding increased the caries risk in a dose-response manner. There was no association between duration of any breastfeeding and dental caries. In conclusion, full breastfeeding for 6-11 months may protect against dental caries in primary teeth. Prolonged breastfeeding was not associated with dental caries in this population., (© 2016 S. Karger AG, Basel.)

Objectives: The aim of the present cohort study was to evaluate the influence of a novel pacifier on the first formation of malocclusion, the anterior open bite in children., Study Design: 129 newborn children whose parents had decided to use pacifiers were randomly attributed to two experimental groups (D=Dentistar, n=56, Novatex, Pattensen, Germany; N=NUK, n=73, Mapa, Zeven, Germany). Children (n=42) who did not use a pacifier were not randomized and served as reference (C). Primary outcome was the presence of anterior open bite. It was hypothesized that D would result in lower incidence when compared to N. At the age of 27 months the children were examined with respect to anterior open bite. Fisher's exact test served to detect significant differences between groups D and N (SPSS 22.0)., Results: 121 children with a mean age of 26.7 months were included in the final analysis (D: n=45; N: n=42; C: n=34). In group D three children (6.7%) showed an anterior open bite. The respective values were 21 (50.0%) for N and 0 for C. The results for group D compared to N were significantly different (chi(2)-test, p<0.001)., Conclusion: In comparison to a commonly used pacifier the novel one causes significantly less anterior open bites.

Objective: The objective of this study is to present information on respiratory inhibition after crying (RIAC), feeding hypoxemia, and respiratory inhibition after gastroesophageal reflux (RIGER) to medical staff caring for infants., Methods: The author reviewed investigations of these conditions., Results: These conditions have been observed in full-term healthy infants, and they are accompanied clinically by central cyanosis and a decrease in SpO2 to less than 70%. These conditions are easily diagnosed using pulse oximetry. Among Japanese infants with a gestational age of 36 weeks or older, the incidence of RIAC and feeding hypoxemia is 24% and 32%, respectively. The incidence of RIGER is approximately 4%. Feeding hypoxemia occurs significantly more often during bottle-feeding than during breastfeeding. RIAC, feeding hypoxemia, and RIGER are significantly associated with each other. The risk factors are maternal smoking during pregnancy, threatened premature labor, twin gestation, asymmetric intrauterine growth restriction, and abnormal cranial ultrasound findings. Almost all infants recover from RIAC by day 7 after birth. Some infants with feeding hypoxemia require additional assistance and monitoring by nursing staff until the day of discharge., Conclusions: Medical staff caring for infants should note the presence of RIAC, feeding hypoxemia, and RIGER.

The aim of the present study was to search for scientific evidence concerning the association between breastfeeding and bottle feeding and risk of malocclusion in mixed and permanent dentitions. An electronic search was performed in eight databases up to February 2015. Additionally, a gray literature search and hand searches of the reference lists of the selected studies were also carried out. There were no restrictions on language or on year of publication. The methodology of the included articles was evaluated using the Newcastle Ottawa scale. Out of the 817 identified citations, six studies fulfilled the eligibility criteria and were included in the systematic review. One study showed that children with mixed and permanent dentitions breastfed for more than 6 months presented greater mean protrusion of mandibular incisors and inclination of maxillary incisors compared with those breastfed for less than 6 months or those who were bottle-fed (p < 0.05). One study revealed that breastfeeding and bruxism were associated with Class II [OR = 3.14 (1.28 - 7.66)] and Class III [OR = 2.78 (1.21 - 6.36)] malocclusion in children with permanent dentition, while another study showed that an increase in breastfeeding duration was associated with a lower risk of malocclusion in children with both mixed and permanent dentitions (p < 0.001). Three studies did not report any significant association. Risk of bias was high in most selected articles. These findings do not support an association between breastfeeding and bottle feeding and the occurrence of malocclusion in mixed and permanent dentitions.

Understanding the role that breastfeeding and bottle feeding play in the development of dental caries during childhood is essential in helping dentists and parents and care providers prevent the disease, and also for the development of effective public health policies. However, the issue is not yet fully understood. The aim of this systematic review and meta-analysis was to search for scientific evidence in response to the question: Do bottle fed children have more dental caries in primary dentition than breastfed children? Seven electronic databases and grey literature were used in the search. The protocol number of the study is PROSPERO CRD 42014006534. Two independent reviewers selected the studies, extracted data and evaluated risk of bias by quality assessment. A random effect model was used for meta-analysis, and the summary effect measure were calculated by odds ratio (OR) and 95% CI. Seven studies were included: five cross-sectional, one case-control and one cohort study. A meta-analysis of cross-sectional studies showed that breastfed children were less affected by dental caries than bottle fed children (OR: 0.43; 95%CI: 0.23-0.80). Four studies showed that bottle fed children had more dental caries (p<0.05), while three studies found no such association (p>0.05). The scientific evidence therefore indicated that breastfeeding can protect against dental caries in early childhood. The benefits of breastfeeding until age two is recommended by WHO/UNICEF guidelines. Further prospective observational cohort studies are needed to strengthen the evidence.

Background: Infancy is a period of rapid growth and habit formation and hence could be a critical period for obesity prevention. Excess weight gain during infancy is associated with later obesity and formula-fed babies are more likely to gain excess weight compared to breastfed babies. The primary trial outcome is a change in the weight standard deviation score from birth to 1 year., Methods/design: We will recruit 650 to 700 parents who introduce formula-milk feeds within 14 weeks of their baby's birth to a single (assessor) blind, parallel group, individually randomised controlled trial. The focus of the intervention is the caregiver (usually the mother), and the focus of the primary outcome is the infant. The intervention group will receive the behavioural intervention, which aims to reduce formula-milk intake, promote responsive feeding and healthy weaning, and prevent excessive weight gain during infancy. The intervention is based on Social Cognitive Theory and action planning ('implementation intentions'). It consists of three components: (1) a motivational component to strengthen parents' motivation to follow the Baby Milk feeding guidelines, (2) an action planning component to help translate motivation into action, and (3) a coping planning component to help parents deal with difficult situations. It will be delivered by trained facilitators (research nurses) over 6 months through three face-to-face contacts, two telephone contacts and written materials. The control group will have the same number of contacts with facilitators, and general issues about feeding will be discussed. Anthropometric outcomes will be measured by trained research staff, blind to group allocation, at baseline, 6 months and 12 months following standard operating procedures. Validated questionnaires will assess milk intake, temperament, appetite, sleep, maternal quality of life and maternal psychological factors. A 4-day food diary will be completed at 8 months., Discussion: The results of the trial will help to inform infant feeding guidelines and to understand the links between infant feeding, behaviour, appetite and growth., Trial Registration: ISRTCN20814693 . Registration date 13 January 2011.