Abstract Objective: To describe the type of milk used to feed infants seen in private pediatric practices in Brazil. To evaluate the relationship between breastfeeding, type of delivery, and history of prematurity. Methods: This is a cross-sectional and observational study that included 4929 infants in the first year of life seen in private pediatric practices in the five geographic regions of Brazil. Mothers provided information about the type of milk used by their infant, the type of delivery (vaginal or cesarean), and whether the birth was premature. Results: Breastfeeding was the only source of milk for 56.1% (1546/2755) of infants in the first six months of life and 32.9% (716/2174) in the second. Of the infants who received other types of milk besides breastfeeding, there was a predominance of infant formula in 98.6% and 93.8% of the infants, respectively, in the first and in the second six months of life. Whole cow's milk was used by 0.7% (20/2755) of infants in the first six months and by 4.1% (90/2174) of infants in the second (p < 0.001). In the first six months of life, breastfeeding as the only type of milk was associated with vaginal delivery (OR = 1.79; p < 0.001) and not having a history of prematurity (OR = 2.48; p < 0.001). Conclusion: Breastfeeding was the only milk source for more than half of infants before 180 days of life. Birth by cesarean section and history of prematurity were negatively associated with breastfeeding as the only source of milk used in infant feeding.

RESUMO A incidência de doença inflamatória intestinal aumentou na população pediátrica nos últimos anos. A forma mais comum de doença inflamatória intestinal é a doença de Crohn e, conforme sua forma e a idade de apresentação é possível prever a evolução da doença.

ABSTRACT The incidence of inflammatory bowel disease in the pediatric population has increased in the last years. The most common form of inflammatory bowel disease is Crohn's disease and, according to its form and age of presentation, it is possible to predict the evolution of the disease.

OBJETIVO: Descrever os resultados da manometria anorretal dos pacientes com constipação intestinal crônica funcional (CICF), refratária aos tratamentos habituais, quanto ao tônus esfincteriano, presença do reflexo inibitório retoanal (RIRA), capacidade de expulsão do balão intrarretal e comportamento durante manobra evacuatória. MÉTODOS: Estudo retrospectivo por meio de análise de prontuários médicos entre janeiro de 2003 e junho de 2007, avaliando-se 31 pacientes ambulatoriais com CICF refratária a tratamentos convencionais por manometria anorretal com cateter de quatro canais (processador MPX 816 e software Proctomaster 5.0, Dynamed). RESULTADOS: Dos 31 pacientes, 24 (77%) eram do sexo masculino. A idade média foi 8,9±2,6 anos. A média de pressão máxima fisiológica do canal anal foi 82±38mmHg. Dos 31 pacientes, 15 (48%) apresentaram esfíncter anal normotônico e 16 (52%), hipertônico. O RIRA esteve presente em todos os casos. A prova de expulsão do balão intrarretal foi positiva em 12/31pacientes, sendo 4/12 com esfíncter normotônico e 8/12 com esfíncter hipertônico (p=0,22). Anismo foi detectado em 6/15 pacientes com esfíncter normotônico (40%) e em 4/16 com esfíncter hipertônico (25%) (p=0,45). CONCLUSÕES: Houve predomínio de esfíncter anal normotônico nos casos de CICF refratária. Pouco mais de 1/3 dos pacientes conseguiram a expulsão do balão durante a prova evacuatória, independentemente da tonicidade do esfíncter anal e cerca de metade dos pacientes apresentavam anismo sem relação com a tonicidade do esfíncter anal. A manometria anorretal é apropriada para o estudo da fisiologia e dinâmica evacuatória e pode ser útil para orientar o tratamento.

OBJECTIVE: To evaluate anorectal manometry results in children with chronic functional intestinal constipation refractory to conventional treatment regarding mean anal sphincter resting pressure, presence of recto-anal inhibitory reflex (RAIR), expulsion capability of the intra-rectal balloon and behavior during the defecation maneuver. METHODS: Retrospective study by review of medical records from January 2003 to June 2007 with 31 patients who presented chronic functional constipation refractory to standard treatment. Anorectal manometry was performed by a four-channel catheter (MPX 816 processor and Proctomaster 5.0 software, Dynamed). RESULTS: Among the 31 studied children, 24 (77%) were male. The mean age was 8.9±2.6 years. The mean maximal squeeze pressure of the anal sphincter was 82±38 mmHg. Among the patients, 15 (48%) had normotonic anal sphincter and 16 (52%) hypertonic anal sphincter. RAIR was present in all patients. Intra-rectal balloon expulsion was positive in 12/31 patients, being 4/12 with normotonic sphincter and 8/12 with hypertonic sphincter (p=0.22). Anism was detected in 6/15 patients with normotonic sphincter (40%) and in 4/16 patients with hypertonic sphincter (25%) (p=0.45). CONCLUSIONS: There was a predominance of normotonic anal sphincter in children with refractory chronic functional constipation. More than 1/3 of the patients were able to expulse the balloon during the defecation test, regardless of anal sphincter resting pressure, and about half of them presented anism not related to the anal sphincter tonus. The anorectal manometry is appropriate to study physiology and evacuatory dynamic, and can be useful to guide the treatment.