ABSTRACT. Objective. To investigate whether supporting fathers to recognize the relevance of their role in the success of breastfeeding and teaching them how to prevent and to manage the most common lactation problems would result in more women breastfeeding.Methods. A controlled trial, in which the participating fathers were allocated in 2-month blocks to a child care training session, was conducted of 280 mothers considering breastfeeding and their 280 partners at a university obstetric department in Naples, Italy. Support and advice about breastfeeding was provided to all of the mothers. Among the fathers of the intervention group, the training session included the management of breastfeeding; among those of the control group, it did not. Primary outcome was the prevalence of full breastfeeding at 6 months. Secondary outcomes were the proportion of women who perceived their milk to be insufficient, who stopped breastfeeding because of problems, and who reported to have received help in breastfeeding management by their partners.Results The prevalence of full breastfeeding at 6 months was 25% (35 of 140) in the intervention group and 15% (21 of 140) in the control group and that of any breastfeeding at 12 months was 19% (27) and 11% (16) Conclusions Teaching fathers how to prevent and to manage the most common lactation difficulties is associated with higher rates of full breastfeeding at 6 months. Pediatrics 2005;116:e494-e498. URL: www.pediatrics.org/ cgi

1 LaPorte R. Assessing the human condition: capturerecapture techniques. BM_ 1994;308:5-6. 2 Hook EB, Regal RR. The value of capture-recapture methods even for apparent exhaustive surveys. The need for adjustment for sources of ascertainment intersection in attempted complete prevalence studies. Am J Epidemiol 1992;135:1060-7 Iron is involved in the metabolism of several neurotransmitters, and monoamine and aldehyde oxidase are reduced in iron deficiency anaemia4, which is common during the second and the third year of life and has been associated with behavioural and development disturbances.' Thus we investigated the association between iron deficiency anaemia and febrile seizures by a case-control study. Patients, methods, and resultsAll 156 children aged 6-24 months admitted to Castellammare di Stabia Hospital, Naples, between 1 January 1993 and 30 June 1995 with diagnosis of febrile convulsions were enrolled in the study. They were healthy children without previous afebrile seizures or central nervous system disease. A febrile convulsion was defined as a seizure that occurred while the child had a rectal temperature of at least 38.3°C or an axillary temperature of at least 37.8°C documented either in the emergency department or in the history. Tvo groups of controls were selected: a random sample of children admitted to the same ward with diagnosis of respiratory and gastrointestinal infection during that period, and a group of healthy children randomly selected from the provincial birth register for an iron deficiency survey in Greater Naples during 1994.Routine haematological investigations were performed for hospitalised patients at hospital admission and for population controls at the Department of Paediatrics of Naples. Data were collected from clinical records by two medical students unaware ofthe study hypothesis.Iron deficiency anaemia was defined as the presence of haemoglobin concentration <105 g/l, mean corpuscular volume <70 fl, and serum iron concentration of <5.4 nmol/l. In our population of this age group the prevalence of anaemia is about 10%; we assumed that a prevalence of 20-25% among cases would be clinically relevant. Relative risk was calculated by odds ratio and 95% confidence interval by Cornfield's method.No differences in distribution of gender, maternal age and education, birth weight and type of birth were found among study groups. Mean age was 15 (SD 5.6) months for cases, 12.4 (5) months for hospital controls, and 13 (2) months for population controls. Anaemia was significantly more common in cases (30%) than hospital (14%) and population (12%) controls (table 1). CommentThe association between iron deficiency anaemia and febrile seizures has not been described before, and chance or unknown confounding are possible explanations. None the less, selection bias as well as confounding by social class do not seem likely in this study.Fever can worsen the negative effects of anaemia or of iron deficiency on the brain and a seizure can occur as a consequence. Alternatively, anaemi...

ABSTRACT. Objective. To describe the long-term outcome of a cohort of children with symptomatic adenotonsillar hypertrophy treated with aqueous nasal beclomethasone.Methods. The children enrolled completed a 4-week single-blind, saline solution controlled crossover study of aqueous beclomethasone (total: 400 g/d). In a 24-week open-label follow-on study, beclomethasone 200 g/d was offered to all patients. During a 100-week follow-up, the degree of nasal obstruction and the frequency of adenotonsillectomy were assessed.Results. Fifty-three children of the 60 enrolled completed the study. After the 4-week crossover trial, the severity of nasal obstruction of 24 children (45%) significantly decreased during the use of nasal steroids, but no child improved when saline solution was used. At 24, 52, and 100 weeks, the 24 children who had initially improved showed a significant decrease of the severity of nasal obstruction and of the frequency of adenotonsillectomy (54% vs 83%) compared with the 29 children who had not responded after the initial steroidal therapy.Conclusions. Evidence from this study suggests that 45% of children with adenoidal hypertrophy improved after 2 weeks of steroidal therapy. Among these children, an additional 24-week treatment at a lower steroid dosage was associated with a significant 52-and 100-week clinical improvement and with reduction of adenotonsillectomy compared with children (55%) who had not responded after the initial 2-week steroidal therapy. Pediatrics 2003;111:e236 -e238. URL: http://www. pediatrics.org/cgi/content/full/111/3/e236; adenotonsillar hypertrophy, topical steroids, adenotonsillectomy.

Aim: The aim of the study was to investigate the frequency of breastfeeding among children with Down syndrome. Methods: The mothers of 560 children with Down syndrome attending four university hospitals in Italy were interviewed and the neonatal clinical records retrieved. Information was collected on the type of infant feeding and on why some mothers had not breastfed their children. Two groups of healthy children whose feeding habits had been previously investigated were recruited as control subjects (1601 and 714, respectively). A paediatrician in each hospital was interviewed about the neonatal admission policy of children with Down syndrome. Results: Among the 560 Down children, 246 (44%) were admitted to the neonatal unit. Compared with the two control groups, children with Down syndrome were significantly more frequently bottle‐fed (57% vs 15% and 24%, respectively, odds ratio 7.5, 95% CI 6.0–9.4 and 4.2, 95% CI 3.3–5.4. respectively). Only 30% of infants admitted to the neonatal unit were breastfed. The main reasons reported by the mothers for not having breastfed were infants’illness in infants who had been admitted to the neonatal unit and frustration or depression, perceived milk insufficiency and difficulty with suckling for those babies who had not been admitted to the unit. The paediatricians reported that the admission of a baby with Down syndrome to the neonatal unit could sometimes take place not for medical reasons, but for diagnostic work‐up or for a more appropriate diagnosis and to maintain communication with the family. Conclusions: Down syndrome babies are less frequently breastfed compared with healthy children. Support in breastfeeding should become a relevant point of health supervision for children with Down syndrome.

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The association between breast feeding and acute lower respiratory infection (ALRI) was studied in a case-control study in southern Italy. Two groups of children were studied: the first group comprised 73 infants, aged 0-6 months, whose diagnosis was pneumonia or bronchiolitis; the second group included 88 infants less than 12 months of age with a diagnosis of pertussis-like illness. Control infants were two groups of infants admitted to the same ward. Compared with controls, infants in the first group were less likely to have been breast fed (odds ratio 0.42, 95% CI 0.19-0.90). The protection conferred by breast feeding was stronger among infants who were receiving human milk at the time of admission (odds ratio 0.22, 95% CI 0.09-0.55) and was absent among those infants who had stopped breast feeding for two or more weeks before admission. Among infants who were severely ill, breast feeding was less likely than among those with milder illnesses. There was evidence in the stratified analysis of effect modification by the presence of other children in the family. Among the infants with pertussis-like illness, the incidence and duration of breast feeding were not different compared with controls. The results suggest that breast feeding has a strong protective effect against ALRI in industrialized countries also. No protection seems to be conferred by human milk against pertussis-like illness.

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WHAT'S KNOWN ON THIS SUBJECT:Immune response to some vaccines is different among breastfed infants compared with those who are not breastfed. WHAT THIS STUDY ADDS:Breastfed infants are less likely to have fever after routine immunizations.abstract OBJECTIVE: The objective of this study was to evaluate the effects of breastfeeding on the risk for fever after routine immunizations. METHODS:A prospective cohort study was conducted at a pediatric vaccination center in Naples, Italy. The mothers of the infants scheduled to receive routine immunizations were instructed on how to measure and record infant temperature on the evening of the vaccination and for the subsequent 3 days. The information about the incidence of fever was obtained by telephone on the third day after vaccination. The relative risk for fever in relation to the type of breastfeeding was estimated in multivariate analyses that adjusted for vaccine dose, maternal education and smoking, and number of other children in the household. RESULTS:A total of 460 infants were recruited, and information on the outcome was obtained for 450 (98%). Fever was reported for 30 (25%), 48 (31%), and 94 (53%) of the infants who were being exclusively breastfed, partially breastfed, or not breastfed at all, respectively (P Ͻ .01). The relative risk for fever among infants who were exclusively and partially breastfed was 0.46 (95% confidence interval: 0.33-0.66) and 0.58 (95% confidence interval: 0.44 -0.77), respectively. The protection conferred by breastfeeding persisted even when considering the role of several potential confounders. CONCLUSIONS:In this study, breastfeeding was associated with a decreased incidence of fever after immunizations.