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O objetivo deste trabalho foi estudar as contribuições dos métodos quantitativos e qualitativos para a construção do conhecimento acerca dos determinantes sociais do processo de desmame, através da comparação entre os achados de pesquisas publicadas entre 2003 e 2009 na base de dados do sistema LILACS. Os determinantes sociais identificados nas investigações quantitativas foram expressos por variáveis de risco, enquanto os identificados nas investigações qualitativas deram visibilidade aos fatores intersubjetivos e objetivos que estruturam a ação social. O entendimento de que quantidade e qualidade são características que compõem os fenômenos complexos leva a propor a triangulação de métodos como uma estratégia para ampliar o conhecimento já existente acerca dos determinantes sociais do processo de desmame, e, assim, poder contribuir para a ampliação do período de amamentação.

This paper aims to study the contributions of quantitative and qualitative methods for the construction of knowledge about the social determinants of the weaning process, by comparing the findings of studies published between 2003 and 2009 in LILACS database system. The social determinants identified in quantitative research were expressed by risk variables, while those identified in the qualitative research gave visibility to inter-subjective and objective factors that shape social action. The realization that the quantity and quality are characteristics that make up the complex phenomena, leads us to the triangulation of methods as a strategy to expand the existing knowledge on social determinants of the weaning process and thereby contribute to the expansion of the breast-feeding period.

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OBJETIVO: Analisar a incidência e os determinantes do uso de mamadeira no primeiro mês de vida e possíveis efeitos dessa prática na técnica de amamentação. MÉTODOS: Estudo transversal aninhado em uma coorte contemporânea de Porto Alegre, RS, de junho a novembro de 2003. Durante um mês foram acompanhados 211 pares de mãe e criança. A influência do uso de mamadeira sobre a técnica de amamentação foi avaliada comparando-se as freqüências de cinco itens desfavoráveis ao posicionamento mãe/criança e três itens desfavoráveis à pega da criança; e as médias do número de itens desfavoráveis entre as duplas que iniciaram o uso mamadeira no primeiro mês e as que não o fizeram. A regressão logística estimou o grau de associação das variáveis com os desfechos, utilizando modelo hierarquizado. RESULTADOS: Aos sete dias, 21,3 por cento das crianças usavam mamadeira e, aos 30 dias, 46,9 por cento. Coabitação com a avó materna esteve associada com uso de mamadeira tanto aos sete quanto aos 30 dias. Também estiveram associados ao uso de mamadeira aos sete dias: a mãe ser adolescente e trauma mamilar na maternidade. Os outros dois fatores associados ao uso de mamadeira aos 30 dias foram trauma mamilar aos sete dias e uso de chupeta aos sete dias. Não houve associação entre técnica de amamentação ensinada na maternidade e uso de mamadeira, mas aos 30 dias, crianças que usavam mamadeira apresentaram técnica menos adequada às que sugavam só no peito. CONCLUSÕES: Os resultados mostram que a mamadeira foi bastante utilizada no primeiro mês de vida, principalmente: em crianças com mães adolescentes e com trauma mamilar, cujas avós maternas estavam presentes no domicílio e que faziam uso de chupeta. Além dos efeitos negativos já conhecidos, a mamadeira pode influenciar negativamente a técnica de amamentação.

OBJECTIVE: To assess incidence rate and determinants of bottle feeding during the first month of life, and its potential effects on breastfeeding technique. METHODS: A nested cross-sectional study was conducted in a contemporary cohort in the city of Porto Alegre, Southern Brazil, between June and November 2003. A total of 211 pairs of healthy mothers and infants were followed up for a month. The effect of bottle feeding on breastfeeding technique was assessed by comparing five items unfavorable to mother-infant positioning and three items unfavorable to infant latch-on; and the average number of unfavorable items between the pairs who started bottle feeding in the first month of life and those who did not. A logistic regression analysis was carried out according to a hierarchical model. RESULTS: By Day 7, 21.3 percent of infants were bottle-fed and 46.9 percent were bottle-fed by Day 30. Living with maternal grandmother was associated with bottle feeding at Days 7 and 30. Maternal age <20 years, and nipple trauma at the maternity hospital were also associated with bottle feeding at Day 7. Other factors associated with bottle feeding at Day 3 were pacifier use at Day 7 and nipple trauma at Day 7. There was no association between the breastfeeding technique taught at the maternity hospital and subsequent bottle feeding. However, at Day 30, the breastfeeding technique was found to be more adequate among exclusively breast-fed infants than those who were also bottle fed. CONCLUSIONS: The study results showed that bottle feeding was quite widespread in the first month of life, mainly in infants born to teenage mothers, with nipple trauma, whose maternal grandmothers were living in the same household, and who were using pacifiers. Besides the already recognized negative effects, bottle feeding may negatively affect breastfeeding technique.

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OBJECTIVE: To assess incidence rate and determinants of bottle feeding during the first month of life, and its potential effects on breastfeeding technique. METHODS: A nested cross-sectional study was conducted in a contemporary cohort in the city of Porto Alegre, Southern Brazil, between June and November 2003. A total of 211 pairs of healthy mothers and infants were followed up for a month. The effect of bottle feeding on breastfeeding technique was assessed by comparing five items unfavorable to mother-infant positioning and three items unfavorable to infant latch-on; and the average number of unfavorable items between the pairs who started bottle feeding in the first month of life and those who did not. A logistic regression analysis was carried out according to a hierarchical model. RESULTS: By Day 7, 21.3% of infants were bottle-fed and 46.9% were bottle-fed by Day 30. Living with maternal grandmother was associated with bottle feeding at Days 7 and 30. Maternal age <20 years, and nipple trauma at the maternity hospital were also associated with bottle feeding at Day 7. Other factors associated with bottle feeding at Day 3 were pacifier use at Day 7 and nipple trauma at Day 7. There was no association between the breastfeeding technique taught at the maternity hospital and subsequent bottle feeding. However, at Day 30, the breastfeeding technique was found to be more adequate among exclusively breast-fed infants than those who were also bottle fed. CONCLUSIONS: The study results showed that bottle feeding was quite widespread in the first month of life, mainly in infants born to teenage mothers, with nipple trauma, whose maternal grandmothers were living in the same household, and who were using pacifiers. Besides the already recognized negative effects, bottle feeding may negatively affect breastfeeding technique.

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This randomized clinical trial compared frequencies of exclusive breastfeeding and lactation-related problems during the first 30 days among 74 mothers who received a 30-minute counseling session on breastfeeding technique in the maternity ward, and 137 controls. The frequency of exclusive breastfeeding among mothers who had received intervention was similar to controls by 7 days (79.7% vs 82.5%, respectively) and 30 days (60.8% vs 53.3%). There was no difference between groups in the frequency of sore nipples at 7 and 30 days, in breast engorgement and mastitis, and in the quality of breastfeeding technique at 30 days. Therefore, a single intervention at maternity was not sufficient to improve breastfeeding technique, increase exclusive breastfeeding rates, and reduce the incidence of breastfeeding problems during the first month.

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OBJECTIVE: To investigate the influence of breastfeeding technique on the frequencies of exclusive breastfeeding and nipple trauma in the first month of lactation. METHODS: We searched for unfavorable parameters of breastfeeding (five related to mother/baby positioning and three related to baby's latch on) in 211 mother-baby pairs in the maternity ward and at day 30, at home. We compared the frequencies of these parameters between mothers practicing or not exclusive breastfeeding at days 7 and 30, and between mothers with or without nipple trauma at the hospital. RESULTS: The number of unfavorable parameters in the maternity ward was similar for mother-baby pairs practicing or not exclusive breastfeeding at day 7 and 30. However, at day 30, it was, on average, lower among those under exclusive breastfeeding, regarding positioning (1.7+/-1.2 vs 2.2+/-1.1; p = 0.009) as well as latch on (1.0+/-0.6 vs 1.4+/-0.6; p < 0.001). The number of unfavorable parameters related to latch on in the maternity ward was similar for women with or without nipple trauma, but women without trauma presented a higher number of unfavorable parameters related to positioning. (2.0+/-1.4 vs 1.4+/-1.2; p = 0.04). CONCLUSIONS: The frequencies of exclusive breastfeeding in the first month and of nipple trauma were not influenced by the breastfeeding technique in the maternity ward, but there was an association between a better technique at day 30 and the practice of exclusive breastfeeding. New studies may help to elucidate whether an improvement in breastfeeding practices over time helps the maintenance of exclusive breastfeeding or whether the introduction of bottle-feeding determines a negative effect on breastfeeding.

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