8.3.09

Does Breastfeeding Protect Against Substantiated Child Abuse and Neglect? A 15-Year Cohort Study

Does Breastfeeding Protect Against Substantiated Child Abuse and Neglect? A 15-Year Cohort Study

Lane Strathearn, MBBS, , Abdullah A. Mamun,, Jake M. Najman, and Michael J. O'Callaghan, MBBS,

PEDIATRICS Vol. 123 No. 2 February 2009, pp. 483-49

OBJECTIVES. We explored whether breastfeeding was protective against maternally perpetrated child maltreatment.

METHODS. A total of 7223 Australian mother-infant pairs were monitored prospectively over 15 years. In 6621 (91.7%) cases, the duration of breastfeeding was analyzed with respect to child maltreatment (including neglect, physical abuse, and emotional abuse), on the basis of substantiated child protection agency reports. Multinomial logistic regression was used to compare no maltreatment with nonmaternal and maternally perpetrated maltreatment and to adjust for confounding in 5890 cases with complete data (81.5%). Potential confounders included sociodemographic factors, pregnancy wantedness, substance abuse during pregnancy, postpartum employment, attitudes regarding infant caregiving, and symptoms of anxiety or depression.

RESULTS. Of 512 children with substantiated maltreatment reports, >60% experienced ≥1 episode of maternally perpetrated abuse or neglect (4.3% of the cohort). The odds ratio for maternal maltreatment increased as breastfeeding duration decreased, with the odds of maternal maltreatment for nonbreastfed children being 4.8 times the odds for children breastfed for ≥4 months. After adjustment for confounding, the odds for nonbreastfed infants remained 2.6 times higher, with no association seen between breastfeeding and nonmaternal maltreatment. Maternal neglect was the only maltreatment subtype associated independently with breastfeeding duration.

CONCLUSION. Among other factors, breastfeeding may help to protect against maternally perpetrated child maltreatment, particularly child neglect

7.3.09

Does Breastfeeding Reduce the Risk of Sudden Infant Death Syndrome?

Does Breastfeeding Reduce the Risk of Sudden Infant Death Syndrome?
M.M. Vennemann, MD, MPH, PDa, T. Bajanowski, MD, PDb, B. Brinkmann, MD, PDa, G. Jorch, MD, PDc, K. Yücesan, MDa, C. Sauerland, MScd, E.A. Mitchell, FRACP, DSce and the GeSID Study Group
PEDIATRICS Vol. 123 No. 3 March 2009, pp. e406-e410

BACKGROUND. In the last 20 years, the prevention campaigns to reduce the risk of
sudden infant death syndrome were very successful. In some countries the advice to
breastfeed is included in the campaigns’ messages, but in other countries it is not.
OBJECTIVE. To examine the association between type of infant feeding and sudden
infant death syndrome.
METHODS. The German Study of Sudden Infant Death is a case-control study of 333
infants who died of sudden infant death syndrome and 998 age-matched controls.
RESULTS.A total of 49.6% of cases and 82.9% of controls were breastfed at 2 weeks of
age. Exclusive breastfeeding at 1 month of age halved the risk, partial breastfeeding
at the age of 1 month also reduced the risk of sudden infant death syndrome, but
after adjustment this risk was not significant. Being exclusively breastfed in the last
month of life/before the interview reduced the risk, as did being partially breastfed.
Breastfeeding survival curves showed that both partial breastfeeding and exclusive
breastfeeding were associated with a reduced risk of sudden infant death syndrome.
CONCLUSIONS. This study shows that breastfeeding reduced the risk of sudden infant
death syndrome by 50% at all ages throughout infancy. We recommend including
the advice to breastfeed through 6 months of age in sudden infant death syndrome
risk-reduction messages

3.3.09

Pediatric Primary Care to Help Prevent Child Maltreatment: The Safe Environment for Every Kid (SEEK) Model

Howard Dubowitz, MD, MS, Susan Feigelman, MD, Wendy Lane, MD and Jeongeun Kim, PhD.
CONTEXT. Effective strategies for preventing child maltreatment are needed. Few primary care–based programs have been developed, and most have not been well evaluated.
OBJECTIVE. Our goal was to evaluate the efficacy of the Safe Environment for Every Kid model of pediatric primary care in reducing the occurrence of child maltreatment.
METHODS. A randomized trial was conducted from June 2002 to November 2005 in a university-based resident continuity clinic in Baltimore, Maryland. The study population consisted of English-speaking parents of children (0–5 years) brought in for child health supervision. Of the 1118 participants approached, 729 agreed to participate, and 558 of them completed the study protocol. Resident continuity clinics were cluster randomized by day of the week to the model (intervention) or standard care (control) groups. Model care consisted of (1) residents who received special training, (2) the Parent Screening Questionnaire, and (3) a social worker. Risk factors for child maltreatment were identified and addressed by the resident physician and/or social worker. Standard care involved routine pediatric primary care. A subset of the clinic population was sampled for the evaluation. Child maltreatment was measured in 3 ways: (1) child protective services reports using state agency data; (2) medical chart documentation of possible abuse or neglect; and (3) parental report of harsh punishment via the Parent-Child Conflict Tactics scale.
RESULTS. Model care resulted in significantly lower rates of child maltreatment in all the outcome measures: fewer child protective services reports, fewer instances of possible medical neglect documented as treatment nonadherence, fewer children with delayed immunizations, and less harsh punishment reported by parents. One-tailed testing was conducted in accordance with the study hypothesis.
CONCLUSIONS. The Safe Environment for Every Kid (SEEK) model of pediatric primary care seems promising as a practical strategy for helping prevent child maltreatment. Replication and additional evaluation of the model are recommended.