Our data suggest that, in most normal infants, the development of hypothalamic-pituitary-adrenal axis circadian maturation may occur at a much earlier age than previously described.

Salivary cortisol is an index of plasma free cortisol and is obtained by a noninvasive procedure. We have been using salivary cortisol as a tool for physiological and diagnostic studies, among them the emergence of circadian rhythm in preterm and term infants. The salivary cortisol circadian rhythm in term and premature infants was established between 8 and 12 postnatal weeks. In the preterm infants the emergence of circadian rhythm was parallel to the onset of sleep rhythm. We also studied the use of salivary cortisol for screening for Cushings syndrome (CS) in control and obese outpatients based on circadian rhythm and the overnight 1 mg dexamethasone (DEX) suppression test. Salivary cortisol was suppressed to less than 100 ng/ dl after 1 mg DEX in control and obese patients. A single salivary cortisol measurement at 23:00 h and again after 1 mg DEX above the 90th percentile of the obese group values had sensitivity and specificity of 93 and 93% (23:00 h), and 91 and 94% (after DEX), respectively. The sensitivity improved to 100% when we combined both parameters. We also studied 11 CS children and 21 age-matched primary obese children for whom salivary cortisol sensitivity and specificity were 100/95% (23:00 h), and 100/95% (1 mg DEX), respectively. Similar to adults, sensitivity and specificity of 100% were obtained by combining 23:00 h and 1 mg DEX. The measurement of salivary cortisol is a useful tool for physiological studies and for the diagnosis of CS in children and adults on an outpatient basis. Correspondence

RESUMOObjetivo: Identificar, na literatura científica, publicações sobre a participação do pai ou companheiro no aleitamento materno.Fontes de dados: Realizou-se uma revisão integrativa no período de 1995 a 2010, utilizando-se os unitermos "pai" e "aleitamento materno" nas bases de dados LI-LACS, SciELO, BDENF e PubMed/MEDLINE. Os dados obtidos foram organizados em três categorias: o pai como suporte para a amamentação; percepções paternas sobre a amamentação; e o impacto da intervenção educativa sobre aleitamento para os pais.Síntese dos dados: Foram identificadas 44 publicações que mostraram que o apoio social, profissional e familiar foi imprescindível para o sucesso do aleitamento materno. O pai foi destacado como suporte fundamental pela forte influência na decisão da mulher em amamentar e na sua continuidade. Contudo, a participação do pai exibe sentimentos ambivalentes: competitividade com a mãe vs. proteção; exclusão vs. aumento do vínculo familiar; apoio vs. preconceitos. Os profissionais de saúde, apontados como referência na busca de informações, mostram-se despreparados para atender aos pais.Conclusões: Foram encontradas várias produções cientí-ficas ressaltando a relevância do apoio paterno para o sucesso do aleitamento materno. Contudo, a maioria das pesquisas apresenta abordagem descritiva, havendo poucos estudos com intervenções educativas.Palavras-chave: aleitamento materno; pai; apoio social. ABSTRACTObjective: To identify publications regarding the role of the father or partner in the breastfeeding practice.Data source: An integrative review of the literature was performed searching for articles published between 1995 and 2010, using the key-words "father" and "breastfeeding" in following databases: LILACS, SciELO, BDENF e PubMed/ MEDLINE. Data were organized in three categories: the supporting role of the father on breastfeeding; paternal perceptions about breastfeeding; and the impact of educational intervention on breastfeeding for parents.Data synthesis: 44 articles showed that social, professional and family support is vital to successful breastfeeding. The father was highlighted as crucial supporter due to his strong influence over women´s decision to breastfeed and to maintain breastfeeding. However, the involvement of the father presents evasive patterns: competition with the mother vs. protection, exclusion vs. increase strength in the family relationships, support vs. prejudices. Health professionals were reported as reference sources of education, however they were shown as unprepared to assist the parents.Conclusions: Several studies on the theme of paternal support were found in the literature, which highlights its importance for successful breastfeeding. However, most of the research had a descriptive approach and there were few studies on educational interventions.

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