Abstracts

Nurses were trained to instruct parents to limit pacifier use; in addition a leaflet about the harmful effects of pacifier use was given to parents. Parents were also informed about the sucking needs and habits of infants and how pacifiers could be used in limited ways.

Aspects presented at the Intervention Clinics in Counseling Parents About pacifier Use:

The use of the pacifier:

• increases the incidence of acute otitis media
• increases the incidence of candidiasis of the mouth
• increases the incidence of caries
• increases the incidence of malocclusion

Thus, pacifier use:

• can be free until the age of 6 months
• should be limited to the moments when the child is falling asleep after the age of six months
• should be terminated after the age of 10 months

In the intervention group a 21 per cent decrease in the use of pacifiers was achieved at the age of 7 to 18 months. A decrease of 29 per cent of acute otitis media occurrence was achieved for the children in the counselled group.

The authors conclude that, "Pacifier use appeared to be a preventable risk factor for acute otitis media in children. Its restriction to the moments when a child is falling asleep effectively prevented episodes of acute otitis media."

What are the most effective means of promoting exclusive breastfeeding? Commentary

Exclusive breastfeeding, the practice of giving only breastmilk and no other foods or liquids with the exception of syrups containing medicines and or vitamin/mineral is recommended for the first six months of life. However, the practice of giving extra water to supplement breastfeeding infants is a common practice, making exclusive breastfeeding uncommon. Although many medical professionals are aware of the anti-infectious factors found in breastmilk and their effectiveness in preventing respiratory, ear and diarrheal infections; the child-spacing benefits; the benefits associated with long term, exclusive breastfeeding such as protection against allergy, overweight, insulin dependent diabetes, and optimal cognitive development, yet, few are cognizant of the fact that these benefits can be reduced by a heavy dose of bacteria from unclean water or milk from bottles which are difficult to clean. Scientific evidence shows that even in hot and arid climates, exclusively breastfed infants have no need for extra water.

Another practice limiting exclusive breastfeeding is the use of prelacteal feeds -- sugar water, honey, rose, spiced water, juice, and sugar cane. Often these may be used to substitute for colostrum and may delay the start of the breastmilk supply. As these practices are often ceremonial, they are more difficult to alter.

The promotion of exclusive breastfeeding is an important public health message to prevent infections and gain optimal benefit from breastfeeding. How can this message be communicated effectively? In low-income countries the message has to be that the use of unclean water and dirty bottles leads to diarrhea and risks death and that breastmilk contains enough water for all the baby's needs even in hot weather. Also of importance is the need to inform mothers well before their child is born and that this information needs to be taught to schoolchildren.

Another concern for mothers in low-income countries is the factor of urbanization. The separation from traditional background and family increases anxiety. This, combined with the need to work for income to support the family may have negative effects on milk supply and lactation duration and increase the risk of additional feeds of water and breastmilk substitutes. In such situations information and support have improved breastfeeding results.

In high-income countries health providers will recommend extra water, glucose water and cow's milk-based substitutes during the first days of life. Here too the dissemination of information and support is essential in establishing exclusive breastfeeding from birth.