Determinants of using pacifier and bottle feeding

Buccini, Gabriela dos Santos; Benício, Maria Helena D'Aquino; Venancio, Sonia Isoyama

doi:10.1590/S0034-8910.2014048005128

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Sumário

Original Articles • Rev. Saúde Pública 48 (4) • Aug 2014 • https://doi.org/10.1590/S0034-8910.2014048005128 copy

Determinants of using pacifier and bottle feeding

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

To analyze the factors associated with the use of pacifiers and/or bottle feeding in infants aged under one year.

METHODS

This is a cross-sectional study with 34,366 children and using data from the database of the 2^nd Nationwide Survey of Breastfeeding Prevalence performed in the Brazilian capitals and Federal District in 2008. Cluster sampling was used. The questionnaire included questions about the use of artificial nipples in the last 24 hours. The analysis considered three outcomes: exclusive use of pacifier, exclusive use of bottle feeding, and use of artificial nipples (pacifier and bottle feeding). Prevalence ratios were obtained using Poisson regression with robust variance following a hierarchical model.

RESULTS

The following factors were associated with exclusive use of the pacifier: mother working outside the home, primiparity, child was not breastfed within the first hour, and child had consumed tea on the first day at home. The following factors were associated with exclusive use of bottle feeding: mother working outside the home, primiparity, low birth weight, child not breastfed within the first hour, and child had consumed milk formula and tea on the first day at home. The following factors were associated with use of artificial nipples (pacifier and bottle feeding): mother working outside the home, primiparity, cesarean delivery, the male gender, low birth weight, born in a hospital not accredited as “baby friendly”, required health baby monitoring in the Primary Health Care Unit (PR = 0.91), and child had consumed milk formula, water, or tea on the first day at home.

CONCLUSIONS

This study identified profiles of exclusive users of pacifiers, bottle feeding, and both. The provided information can guide preventive practices for child health.

Bottle Feeding; Pacifiers, utilization; Maternal and Child Health; Cross-Sectional Studies

Variable	Total N^a	Exclusive use of pacifier (%)	PR_adjusted	95%CI	p
Distal block (1)
Maternal age (years)					0.122^b
20 to 35	9,017	21.3	1
< 20	3,044	23.0	1.09	0.97;1.24	0.119
> 35	1,372	21.9	1.03	0.88;1.21	0.685
Maternal education (years)					0.161^b
> 12	1,795	24.8	1
9 to 12	6,363	21.7	0.90	0.77;1.03	0.139
0 to 8	5,189	20.9	0.90	0.76;1.02	0.093
Maternal work					0.016^b
Not working outside the home	9,025	20.6	1
On maternity leave	1,964	26.9	1.13	0.99;1.29	0.076
Working outside the home	1,678	23.1	1.16	1.00;1.35	0.045
Primiparity
No	7,079	19.3	1
Yes	6,114	24.8	1.28	1.16;1.41	< 0.001
Intermediate block (2 to 3)
Type of delivery
Normal/Forceps	7,582	20.7	1
Cesarean	6,862	23.0	1.10	1.00;1.21	0.049
Infant gender
Female	7,395	20.8	1
Male	7,173	22.8	1.10	1.00;1.21	0.041
Low birth weight ( < 2,500 g)
No	13,182	22.1	1
Yes	1,069	20.4	0.90	0.74;1.10	0.297
Born in Baby-Friendly Hospital
Yes	5,092	21.5	1
No	8,385	22.1	1.02	0.92;1.13	0.611
Routine health care services
Family Health Strategy	3,715	23.4	1
Basic health care unit	4,514	20.7	0.89	0.79;1.01	0.088
Private health care services	4,747	23.4	1.00	0.89;1.13	0.923
Proximal block (4A)
Breastfed within first hour of birth
Yes	9,976	20.3	1
No	3,886	24.8	1.19	1.08;1.32	0.001
Proximal block (4B)
Breastfed on the first day after hospital discharge
Yes	7,310	25.6	1
No	168	23.8	0.94	0.66;1.33	0.744
Consumed processed milk on the first day after hospital discharge
No	7,021	25.3	1
Yes	384	28.9	1.16	0.91;1.48	0.219
Consumed water on the first day after hospital discharge
No	7,219	25.6	1
Yes	186	23.3	0.96	0.62;1.48	0.873
Consumed tea on the first day after hospital discharge
No	7,052	25.2	1
Yes	337	32.0	1.30	1.01;1.67	0.040

Variable	PR_adjusted	95%CI	p
Model 1^a
Maternal work			0.017^d
Not working outside the home	1
On maternity leave	1.11	0.96;1.27	0.139
Working outside the home	1.18	1.01;1.37	0.034
Primiparity
No	1
Yes	1.28	1.15;1.42	< 0.001
Model 3^b
Breastfed within the first hour after birth
Yes	1
No	1.15	1.03;1.29	0.014
Model 4^c
Ingested tea on the first day after birth
No	1
Yes	1.37	1.05;1.79	0.020

Variable	Total N^a	Exclusive use of baby bottles (%)	PR_adjusted	95%CI	p
Distal block (1)
Maternal age (years)					0.274^b
20 to 35	12,127	40.6	1
< 20	4,243	42.0	1.02	0.96;1.08	0.433
> 35	1,897	44.5	1.07	0.98;1.15	0.090
Maternal education (years)					0.008^b
> 12	2,419	44.7	1
9 to 12	8,725	41.4	0.93	0.87;1.00	0.073
0 to 8	7,036	40.3	0.90	0.83;0.96	0.006
Maternal work					< 0.001^b
Not working outside the home	12,171	39.0	1
On maternity leave	1,985	26.6	0.99	0.88;1.12	0.953
Working outside the home	3,089	60.3	1.40	1.33;1.48	< 0.001
Primiparity
No	9,424	38.7	1
Yes	8,501	44.3	1.13	1.07;1.19	< 0.001
Intermediate block (2 to 3)
Type of delivery
Normal/Forceps	10,526	41.6	1
Cesarean	9,698	45.0	1.08	1.03;1.13	0.001
Child gender
Female	10,287	42.3	1
Male	10,137	44.2	1.01	0.97;1.06	0.488
Low birth weight (< 2,500 g)
No	18,188	42.4	1
Yes	1,711	49.6	1.18	1.09;1.27	< 0.001
Born in Baby-Friendly Hospital
Yes	6,993	41.9	1
No	11,881	44.2	1.05	1.00;1.10	0.050
Routine health care services
Family Health Strategy	5,129	42.1	1
Basic health care unit	6,371	41.6	0.96	0.90;1.02	0.252
Private health care services	6,854	47.3	1.08	1.02;1.14	0.008
Proximal block (4A)
Breastfed within the first hour after birth
Yes	13,793	24.9	1
No	5,485	38.7	1.55	1.15;2.09	0.003
Proximal block (4B)
Breastfed on the first day after hospital discharge
Yes	7,467	24.9	1
No	197	38.7	1.50	1.12;2.03	0.007
Consumed processed milk on the first day after hospital discharge
No	7,007	22.8	1
Yes	580	51.4	2.20	1.91;2.52	< 0.001
Consumed water on the first day after hospital discharge
No	7,318	24.6	1
Yes	266	41.3	1.54	1.21;1.94	< 0.001
Consumed tea on the first day after hospital discharge
No	7,079	23.3	1
Yes	493	52.2	2.15	1.86;2.49	< 0.001

Variable	PR_adjusted	95%CI	p
Model 1^a
Maternal work			< 0.001^e
Not working outside the home	1
On maternity leave	0.97	0.86;1.10	0.708
Working outside the home	1.39	1.32;1.47	< 0.001
Primiparity
No	1
Yes		1.06;1.17	< 0.001
Model 2^b
Low birth weight
No	1
Yes	1.21	1.11;1.31	< 0.001
Model 3^c
Breastfed within the first hour after birth
Yes	1
No	1.08	1.02;1.15	0.004
Model 4^d
Consumed processed milk on the first day after hospital discharge
No	1
Yes	1.82	1.52;2.19	< 0.001
Consumed tea on the first day after hospital discharge
No	1
Yes	1.96	1.63;2.36	< 0.001

Variable	Total N^a	Use of artificial nipples (%)	PR_adjusted	95%CI	p
Distal block (1)
Maternal age (years)					0.004^b
20 to 35	12,809	46.8	1
< 20	4,584	50.1	1.07	1.02;1.13	0.008
> 35	2,018	50.6	1.06	0.99;1.14	0.072
Maternal education (years)					< 0.001^b
> 12	2,783	55.7	1
9 to 12	9,056	47.1	0.86	0.81;0.91	< 0.001
0 to 8	7,479	46.6	0.84	0.79;0.89	< 0.001
Maternal work					< 0.001^b
Not working outside the home	12,550	43.8	1
On maternity leave	2,148	34.1	0.97	0.88;1.08	0.644
Working outside the home	3,562	69.1	1.45	1.39;1.52	< 0.001
Primiparity
No	9,680	43.2	1
Yes	9,349	52.9	1.21	1.16;1.26	< 0.001
Intermediate block (2 to 3)
Type of delivery
Normal/Forceps	11,132	48.4	1
Cesarean	10,718	52.7	1.09	1.04;1.13	< 0.001
Child gender
Female	11,021	49.4	1
Male	11,097	52.1	1.04	1.00;1.08	0.016
Low birth weight (< 2,500 g)
No	19,657	49.9	1
Yes	1,866	55.2	1.11	1.05;1.19	< 0.001
Born in Baby-Friendly Hospital
Yes	7,496	45.5	1
No	12,812	53.0	1.15	1.10;1.20	< 0.001
Routine health care services
Family Health Strategy	5,521	49.6	1
Basic health care unit	6,528	46.7	0.93	0.88;0.98	0.011
Private Health Care Service	7,723	56.5	1.09	1.05;1.15	< 0.001
Proximal block (4A)
Breastfed within the first hour after birth
Yes	14,669	49.0	1
No	6,129	52.5	1.09	1.05;1.14	< 0.001
Proximal block (4B)
Breastfed on the first day after hospital discharge
Yes	8,082	33.5	1
No	399	72.4	2.11	1.91;2.33	< 0.001
Consumed processed milk on the first day after hospital discharge
No	7,493	30.6	1
Yes	910	70.5	2.25	2.08;2.44	< 0.001
Consumed water on the first day after hospital discharge
No	7,952	33.6	1
Yes	438	66.2	1.87	1.67;2.08	< 0.001
Consumed tea on the first day after hospital discharge
No	7,746	33.1	1
Yes	639	64.0	1.87	1.70;2.06	< 0.001

Variable	PR_adjusted	95%CI	p
Model 1^a
Maternal work			< 0.001^f
Not working outside the home	1
On maternity leave	0.95	0.86;1.07	0.447
Working outside the home	1.43	1.37;1.51	< 0.001
Primiparity
No	1
Yes	1.21	1.15;1.27	< 0.001
Model 2^b
Type of delivery
Normal/Forceps	1
Cesarean	1.06	1.01;1.12	0.008
Child gender
Female	1
Male	1.07	1.02;1.12	0.003
Low birth weight
No	1
Yes	1.11	1.03;1.19	0.005
Model 3^c
Born in Baby-Friendly Hospital
Yes	1
No	1.12	1.06;1.18	< 0.001
Routine health care services
Family Health Strategy	1
Basic Health Care Unit	0.91	0.86;0.97	0.005
Private health care services	1.02	0.96;1.09	0.397
Model 4^d
Breastfed within the first hour after birth
Yes	1
No	1.06	1.00;1.11	0.030
Model 5^e
Consumed processed milk on the first day after hospital discharge
No	1
Yes	2.06	1.83;2.31	< 0.001
Consumed water on the first day after hospital discharge
No	1
Yes	1.18	1.01;1.37	< 0.001
Consumed tea on the first day after hospital discharge
No	1
Yes	1.38	1.21;1.59	< 0.001

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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[1] Correspondence: Gabriela dos Santos Buccini. Departamento de Nutrição. Av. Dr. Arnaldo, 715 Cerqueira César. 02146-904 São Paulo, SP, Brasil. E-mail:gabibuccini@usp.br