Breastfeeding in Children with Down Syndrome

Breastfeeding in Children with Down Syndrome | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Breastfeeding in Children with Down Syndrome Alejandra Ochoa Rodríguez, Silvestre García de la Puente, Karla Adney Flores Arizmendi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4413101/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 31 May, 2025 Read the published version in BMC Pediatrics → Version 1 posted 15 You are reading this latest preprint version Abstract Introduction. Babies with Down syndrome (DS) present physical characteristics that can make breastfeeding difficult, including hypotonia of the muscles of the oral cavity and pharynx which can create problems with sucking and swallowing. Breastfeeding has proven beneficial for babies, and it is recommended to be exclusive for the first 6 months. However, babies born with DS have a higher probability of not being breastfed. Objective. Describe the frequency and characteristics of breastfeeding in children with DS at the National Institute of Pediatrics, Mexico City. Materials and Methods. This was an observational, descriptive, prospective, and cross-sectional study with 100 mothers concerning their breastfeeding experience, using the 2019 ENSANUT questionnaire. The analysis was performed with descriptive statistics. Results. The mothers reported that 98% of their babies had received mother’s milk at least once and that 64% had received infant formula in the first three days of life. The median duration of breastfeeding was three months; 32.4% of the babies were exclusively breastfed for 6 months. Risk factors for not being breastfed were problems with sucking, swallowing, and not providing feeding on demand, as well as improper technique. Conclusions. Only 32% of babies were exclusively breastfed, for various reasons. Down Syndrome breastfeeding risk factors Introduction Down syndrome (DS) is a genetic condition that includes a third copy of chromosome 21. It is one of the most frequently diagnosed syndromes in children, occurring in one of every 700 live births [ 1 ]. Patients with DS present physical characteristics that can make breastfeeding difficult, such as changes in oral anatomy (high-arched palate, relative macroglossia, malocclusion of up to 90%) and hypotonia of the muscles of the oral cavity and pharynx [ 2 ]. These characteristics can lead to difficulties in sucking and swallowing. Up to 58% of children with DS also present dysphagia and aspiration of liquids [ 3 ]. Breastfeeding has proven to be beneficial for babies, with no contraindications, in the short and the long term [ 4 ]. The World Health Organization (WHO) recommends breastfeeding during the first hour of life, that babies be exclusively breastfed on demand for their first 6 months of life, with complementary feeding at 6 months, and that breastfeeding continue to the age of 2 years or more [ 5 ]. However, babies born with DS have a greater probability of not being breastfed, especially if they present a cardiopathy [ 3 ]. Babies with DS are breastfed an average of 54 days, in comparison to 164 days for those without any disability [ 6 ]. There have been no studies in Mexico of breastfeeding of children with DS, or of the difficulties in carrying it out. The objective of this study was to describe the frequency and characteristics of breastfeeding of Mexican children with DS seen at the National Institute of Pediatrics (Instituto Nacional de Pediatría, INP). The study was approved by the Research Ethics Committees of the INP (Approval No. 2022/031). Materials and Methods This was an observational, descriptive, prospective, and cross-sectional study of patients under 5 years of age seen in the Comprehensive Care Clinic for Children with Down Syndrome in 2022. The patients’ mothers agreed to participate in the study and provided written informed consent. Mothers were questioned about their experience with breastfeeding using the 2019 ENSANUT questionnaire [ 7 ] and their responses were noted. Where mothers were not fully familiar with the medical histories of their children, missing data were taken from patients’ electronic charts. Descriptive statistics were used to summarize the data: numerical variables with medians, minima, and maxima, and categorical variables with frequencies and percentages. Results A total of 100 surveys were applied to mothers of children under 5 years of age who were patients at the Down Syndrome Clinic at the National Pediatrics Institute. The mothers agreed to participate in the study and provided informed consent. Table 1 shows the numerical variables. The median age of the mothers was 33.5 years, with a minimum of 16 and a maximum of 45. The median time until the first feeding with mother’s milk was 4 hours, with a minimum of 2 minutes and a maximum of 30 days in one case. At the time of the interview, the median time during which babies were breastfed was 91.5 days. Mothers currently breastfeeding (38%) were asked how long they planned to continue, and their median response was 24 months. Table 1 Numerical Variables Numerical Variable n median min. max. Age of child (months) 100 15.5 15 days 59 Age of mother (years) 100 33.5 16 45 Time to first breastfeeding (minutes) 99 240 2 43,200 No. of daytime feedings, first 6 months 100 8 0 15 No. of nighttime feedings, first 6 months 100 3 0 8 Total time breastfeeding (days) 100 91.5 0 1275 Planned time breastfeeding (months) 37 24 12 36 Table 2 shows categorical data for mothers and children. A total of 17% of the mothers received gifts in the hospital, with the most frequent being infant formula (70%) and bottles and pacifiers (11.8%); the rest did not recall what they had received. Of the children, 54 were boys, 60% had a heart disease, 29% had a gastrointestinal disorder (of whom 34% required surgical intervention), 90% had a high-arched palate, 38% had problems with sucking, and 18% had problems with swallowing. Table 2. Categorical Variables for Mothers and Children Variable n Mother’s Education Undergraduate or graduate degree High school Junior high school Elementary school 23 42 25 10 Gifts in hospital No Yes 83 17 Child’s Sex Male Female 54 46 Child with heart disease No Yes 40 60 Child with digestive disorders No Major disorders Minor disorders 71 20 9 High-arched palate No Yes 10 90 Problems with sucking No Yes 62 38 Problems with swallowing No Yes 82 18 Data on children’s feeding are shown in Table 3 . A total of 98 children received mother’s milk at least once, either directly from the mother or by other means. Among those who were hospitalized during their first days of life, 64 received infant formula during their first 3 days, some in combination with mother’s milk and others exclusively. Once at home, 90 children were fed on demand, 52 mothers used a bottle with mother’s milk (the majority of these frequently), and 65 used infant formula. Mothers’ responses to questions about technique during breastfeeding (position of mother and baby, pain, clicking sounds) and afterwards (number of diapers, crying after feeding) indicated that up to 36% had a faulty technique. Table 3. Data on Feeding Variable n Ever breastfed No Yes 2 98 Infant formula in first 3 days No Yes 37 63 Feeding on demand No Yes 10 90 Use of bottle with mother’s milk No Yes Attempted 39 52 9 Feeding at home with infant formula No Yes 35 65 Reason for feeding with infant formula Mother’s decision Low milk supply Other 37 21 7 Proper breastfeeding technique No Yes 36 64 Breastfeeding continued through date of interview No Yes 62 38 The factors associated with a baby being exclusively breastfed were analyzed. There were 74 babies who were at least 6 months old at the time of the interview. Of these, 24 (32%) were exclusively breastfed. Table 4 shows the significant associations in a bivariate analysis: babies with the greatest probability of being exclusively breastfed were those without problems with sucking or swallowing, whose mothers used proper breastfeeding technique, who were fed on demand, and whose mothers were youngest. Table 4 Bivariate Analysis of Babies Exclusively Breastfed for 6 Months Yes No p Variable Problems with sucking Yes 4 (16.7%) 28 (56%) No 20 (83.3%) 22 (44%) ˂0.001 * Problems with swallowing Yes 2 (8.3) 15 (30%) No 22 (91.7) 35 (70%) 0.038 * Proper technique Yes 24 (100%) 20 (40%) No 0 30 (60%) ˂0.001 * Feeding on demand Yes 24 (100%) 42 (84%) No 0 8 (16%) 0.048 ** Mother’s age Median 29.5 35 0.068 *** * Pearson’s Χ 2 . ** Fisher’s exact test. *** Mann-Whitney U A multivariate logistic regression analysis (Table 5 ) found that the only significant variables were sucking and mother’s age, both with a negative B coefficient, indicating that the probability of exclusive breastfeeding was higher in the absence of sucking problems and with mothers who were younger. A Hosmer-Lemeshow test showed that the model was good. Table 5 Logistic Regression Analysis of Babies Exclusively Breastfed for 6 Months. 95% CI OR Variable B p OR Lower Upper Problems with sucking -2.238 0.001 0.107 0.028 0.408 Mother’s age − .092 0.017 0.913 0.847 0.983 Constant 2.917 0.025 18.48 CI: confidence interval; OR: odds ratio. Patients were subsequently evaluated who had completed a minimum of 12 months of breastfeeding ( n = 62). Of these, 30.6% continued breastfeeding with complementary feeding. The results (Table 6 ) show that the variables associated with continued breastfeeding at one year were the absence of problems with sucking, proper breastfeeding technique, and mothers who were younger. A logistic regression analysis (Table 7 ) produced results similar to the previous one: the significant variables were sucking and mother’s age. Table 6 Bivariate Analysis of Breastfeeding for 12 Months. Variable Yes No p Problems with sucking Yes 2 (10.5%) 27 (62.8%) No 17 (89.5%) 16 (37.2%) ˂0.001 * Proper technique Yes 19 (100%) 17 (39.5%) No 0 26 (60.5%) ˂0.001 * Mother’s age Median 30 35 0.085 ** * Pearson’s Χ 2 . ** Mann-Whitney U . Table 7 Logistic Regression Analysis of Breastfeeding for Twelve Months. 95% CI Variable β p OR Lower Upper Problems with sucking -3.15 0.001 0.043 0.007 0.255 Mother’s age -0.107 0.022 0.899 0.820 0.985 Constant 3.554 0.025 34.954 CI: confidence interval; OR: odds ratio. Discussion Breastfeeding is an important public health measure in every country. It is the first tool we have for ensuring people’s health, providing for adequate nutrition, proper development, and a reduction in infectious diseases and their complications [ 8 ]. The proportion of babies in this study who were breastfed, irrespective of technique or whether breastfeeding continued, was 98%, similar to that reported in Chile (95.9%), Brazil (84.2%), the United Kingdom (92.5%), the United States (92.5%), and Puerto Rico (84.3%), but different from countries such as New Zealand, Croatia, and Italy, where fewer than 50% of babies with DS are breastfed [ 6 ]. In these countries, babies born with DS have a lower probability of being breastfed, and the proportion is even lower if they have a heart disease. In Mexico, most mothers try to breastfeed, which is clearly a good starting point, but we found that only 29% continued breastfeeding complemented with other nutrition at the age of 12 months. The rest did not receive the benefits of improved nutrition, digestion, lipids promoting neurodevelopment, or protection against infection during their first year of life, which is when they tend to have a greater number of respiratory and gastrointestinal infections. Of the children in this study, 71% did not receive the minimum necessary breastfeeding time recommended by the WHO. Some of the most important measures recommended by the WHO for successful breastfeeding are to respect the “golden hour,” when mother and baby have skin-to-skin contact and the baby is offered milk during the first 40 minutes of life, to have the baby in the same room as the mother, to breastfeed on demand from birth, to provide information and ensure that mothers use proper technique, and not to offer any gifts in the hospital related to feeding that do not support breastfeeding. Most participants in our study had their first feeding 4 hours after birth, with infant formula for the first and some subsequent feedings. Among the mothers in our study, 17% had received a gift related to feeding, and 70% of those gifts were infant formula. Colon et al., in a study in Puerto Rico, found that 50% of mothers were not given their babies while they were in the hospital, whether they were healthy or not [ 9 ]. Where babies did not breastfeed successfully, it was in many cases because their mothers did not use proper technique, generally for lack of information. We found that failure to breastfeed on demand in the first 6 months is a risk factor for not breastfeeding throughout that period. During the first 6 months, 67.6% of mothers in our study used infant formula, either exclusively or in conjunction with breastfeeding. This figure is alarming, and a marked contrast with countries like Chile, where only 23.3% use exclusively formula [ 6 ]. Improving these figures requires developing public policy in hospitals, with ongoing training so that health personnel are well informed and can ensure that mothers have fully understood the technique and advantages of breastfeeding before they leave the hospital with their babies. Among the factors related to the baby, we found, as expected, that problems with sucking or swallowing were important risk factors, but were not related to other comorbidities, such as heart disease or gastrointestinal disorders. An interesting finding in our study was that the younger the mother, the greater the possibility was that the baby would successfully breastfeed for a longer period of time. This is in contrast to data from the ENSANUT, where the majority of babies breastfeeding for at least two years had mothers aged 20–59 years [ 10 ]. Conclusions In Mexico, breastfeeding continues to be an area of concern, requiring further effort both with health care workers and with families. Breastfeeding is abandoned more often than it should be, often on medical instructions or for lack of information for mothers . In the case of babies with DS, there are multiple factors that may interfere with successful breastfeeding. The most important of these is problems with sucking, but there are other variables that can be addressed, such as education of mothers in proper technique and feeding on demand. Declarations Compliance with Ethical Standards This work was approved by the Research and Research Ethics Boards of the National Institute of Pediatrics, Mexico City, (Approval No. 2022/031; IRB00008064 and IRB00008065, NIH Office for Human Research Protections, http://ohrp.cit.nih.gov/search/search.aspx), according to the principles of the Helsinki Declaration. A copy of the approvals is available upon request. The study was considered to be of minimal risk, as it consisted only of a survey of mothers about breastfeeding, without risk to the life or functioning of the participants. Interviews were performed at no cost. Written informed consent was obtained from parents or guardians. The informed consent process and the objectives of the study were explained to the mothers and their questions were answered. It was explained that the decision to participate or not to participate would not affect the care they received. Names and other personal information not relevant to the study were not used, and all information collected was securely stored by the researchers. Consent for Publication Not applicable. Financing This work received financial support from the Instituto Nacional de Pediatría (Project No. 2022/031). Conflicts of Interest None. Availability of Data and Materials All data generated or analyzed during this study are included in this published article and its supplementary information files. Acknowledgments None. Authors’ Contributions All authors contributed to the study conception and design. Conceptualization and data curation were performed by Karla Adney Flores Arizmendi, research was carried out by Alejandra Ochoa Rodríguez, data were analyzed by Silvestre García de la Puente, and the manuscript was written, reviewed, and edited by Silvestre García de la Puente, Alejandra Ochoa Rodríguez and Tania Tonantzin Vargas Robledo. The first draft of the manuscript was written by Silvestre García de la Puente and Alejandra Ochoa Rodríguez. All authors read and approved the final manuscript. References Lagan N, Huggard, D, Mc Grane F, Leahy TR, Franklin O, Roche E, et al. Multiorgan involvement and management in children with Down syndrome. Acta Paediatrica. 2020;109(6):1096–1111. DOI:10.1111/apa.15153. Shukla D, Bablani D, Chowdhry A, Thapar R, Gupta P, Mishra S. Dentofacial and cranial changes in Down syndrome. Osong Public Health Res Perspect. 2014 5(6):339-44. DOI: 10.1016/j.phrp.2014.09.004. Agostini, CO, Poloni, S., Barbiero, SM, Vian, I. Prevalence of breastfeeding in children with congenital heart diseases and Down syndrome. Clin Nutr ESPEN. 2021; 44:458-462. doi: 10.1016/j.clnesp.2021.03.023. Brahm P, Valdés V. Beneficios de la lactancia materna y riesgos de no amamantar. Rev Chil Pediatr. 2017;88(1): 7-14. DOI: 10.4067/S0370-410620170001000001 Who.int. Breastfeeding . https://www.who.int/es/health-topics/breastfeeding#tab=tab_2. Consulted 1 Abril 2022. Magenis ML, de Faveri W, Castro K, Forte GC, Grande AJ, Perry IS. Down syndrome and breastfeeding: A systematic review. J Intellect Disabil. 2020; 25: 1-20. doi: 10.1177/1744629520970078. INEGI. Lactancia materna y prácticas de alimentación complementaria (0 a 36 meses). https:www.inegi.org.mx/contenidos/programas/Ensanut/2018/doc/ensanut 2018 lactancia materna practicas alimentación.pdf,. Consulted 29 June 2024. Binns C, Lee M, Low WY. The Long-Term Public Health Benefits of Breastfeeding. Asia Pac J Public Health. 2016 Jan;28(1):7-14. doi: 10.1177/1010539515624964. Colón E, Dávila-Torres RR, Parrilla-Rodríguez AM, Toledo A, Gorrín-Peralta JJ, Reyes-Ortiz VE. Exploratory study: barriers for initiation and/or discontinuation of breastfeeding in mothers of children with Down syndrome. P R Health Sci J. 2009; 28(4):340-4. PMID: 19999242. Sánchez-Pérez A, Velázquez-Lerma R, Díaz-Vargas P, Molina Nava MCD. Práctica de la lactancia materna en México. Análisis con datos de la Encuesta Nacional de la Dinámica Demográfica (ENADID) 2014. Real datos y Espac Rev Int Estadística y Geogr. 2019;10(1):4-17. NIH Office for Human Research Protection. http://ohrp.cit.nih.gov/search/search.aspx. Consulted 7 April 2024. Additional Declarations No competing interests reported. Supplementary Files Breastfeeding.database.xlsx Cite Share Download PDF Status: Published Journal Publication published 31 May, 2025 Read the published version in BMC Pediatrics → Version 1 posted Editorial decision: Revision requested 25 Jun, 2024 Reviews received at journal 24 Jun, 2024 Reviews received at journal 18 Jun, 2024 Reviews received at journal 18 Jun, 2024 Reviews received at journal 07 Jun, 2024 Reviewers agreed at journal 06 Jun, 2024 Reviewers agreed at journal 04 Jun, 2024 Reviewers agreed at journal 03 Jun, 2024 Reviewers agreed at journal 03 Jun, 2024 Reviewers agreed at journal 03 Jun, 2024 Reviewers invited by journal 03 Jun, 2024 Editor assigned by journal 20 May, 2024 Editor invited by journal 20 May, 2024 Submission checks completed at journal 20 May, 2024 First submitted to journal 13 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4413101","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":307941058,"identity":"f66d583b-16d3-4e3d-9ef6-7b9a901c32ac","order_by":0,"name":"Alejandra Ochoa Rodríguez","email":"","orcid":"","institution":"Instituto Nacional de Pediatría","correspondingAuthor":false,"prefix":"","firstName":"Alejandra","middleName":"Ochoa","lastName":"Rodríguez","suffix":""},{"id":307941059,"identity":"9a4bcb0d-f008-497b-b4d2-2e832f9da5c1","order_by":1,"name":"Silvestre García de la Puente","email":"data:image/png;base64,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","orcid":"","institution":"Instituto Nacional de Pediatría","correspondingAuthor":true,"prefix":"","firstName":"Silvestre","middleName":"García de la","lastName":"Puente","suffix":""},{"id":307941060,"identity":"bb378b02-0d56-40dc-b1a0-bc004c23eb9d","order_by":2,"name":"Karla Adney Flores Arizmendi","email":"","orcid":"","institution":"Down Syndrome Clinic, Instituto Nacional de Pediatría","correspondingAuthor":false,"prefix":"","firstName":"Karla","middleName":"Adney Flores","lastName":"Arizmendi","suffix":""},{"id":307941061,"identity":"a96d38f7-a3a8-4cef-8067-1140a86bc032","order_by":3,"name":"Tania Tonantzin Vargas Robledo","email":"","orcid":"","institution":"Instituto Nacional de Pediatría","correspondingAuthor":false,"prefix":"","firstName":"Tania","middleName":"Tonantzin Vargas","lastName":"Robledo","suffix":""}],"badges":[],"createdAt":"2024-05-13 12:07:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4413101/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4413101/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12887-024-05363-0","type":"published","date":"2025-05-31T15:57:53+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":83783086,"identity":"a899c559-fadc-4d41-ad06-87406d124b15","added_by":"auto","created_at":"2025-06-02 16:10:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":549975,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4413101/v1/b55fac03-86aa-4c95-a17c-fec335810722.pdf"},{"id":57466078,"identity":"17a9ffe7-a442-41c2-aba8-8dc15ff67ebe","added_by":"auto","created_at":"2024-05-31 04:42:34","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":180213,"visible":true,"origin":"","legend":"","description":"","filename":"Breastfeeding.database.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4413101/v1/bb91c73f4083158548fe8a39.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Breastfeeding in Children with Down Syndrome","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDown syndrome (DS) is a genetic condition that includes a third copy of chromosome 21. It is one of the most frequently diagnosed syndromes in children, occurring in one of every 700 live births [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Patients with DS present physical characteristics that can make breastfeeding difficult, such as changes in oral anatomy (high-arched palate, relative macroglossia, malocclusion of up to 90%) and hypotonia of the muscles of the oral cavity and pharynx [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These characteristics can lead to difficulties in sucking and swallowing. Up to 58% of children with DS also present dysphagia and aspiration of liquids [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBreastfeeding has proven to be beneficial for babies, with no contraindications, in the short and the long term [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The World Health Organization (WHO) recommends breastfeeding during the first hour of life, that babies be exclusively breastfed on demand for their first 6 months of life, with complementary feeding at 6 months, and that breastfeeding continue to the age of 2 years or more [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, babies born with DS have a greater probability of not being breastfed, especially if they present a cardiopathy [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Babies with DS are breastfed an average of 54 days, in comparison to 164 days for those without any disability [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere have been no studies in Mexico of breastfeeding of children with DS, or of the difficulties in carrying it out. The objective of this study was to describe the frequency and characteristics of breastfeeding of Mexican children with DS seen at the National Institute of Pediatrics (Instituto Nacional de Pediatr\u0026iacute;a, INP). The study was approved by the Research Ethics Committees of the INP (Approval No. 2022/031).\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e This was an observational, descriptive, prospective, and cross-sectional study of patients under 5 years of age seen in the Comprehensive Care Clinic for Children with Down Syndrome in 2022. The patients\u0026rsquo; mothers agreed to participate in the study and provided written informed consent. Mothers were questioned about their experience with breastfeeding using the 2019 ENSANUT questionnaire [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and their responses were noted. Where mothers were not fully familiar with the medical histories of their children, missing data were taken from patients\u0026rsquo; electronic charts. Descriptive statistics were used to summarize the data: numerical variables with medians, minima, and maxima, and categorical variables with frequencies and percentages.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 100 surveys were applied to mothers of children under 5 years of age who were patients at the Down Syndrome Clinic at the National Pediatrics Institute. The mothers agreed to participate in the study and provided informed consent.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the numerical variables. The median age of the mothers was 33.5 years, with a minimum of 16 and a maximum of 45. The median time until the first feeding with mother\u0026rsquo;s milk was 4 hours, with a minimum of 2 minutes and a maximum of 30 days in one case. At the time of the interview, the median time during which babies were breastfed was 91.5 days. Mothers currently breastfeeding (38%) were asked how long they planned to continue, and their median response was 24 months.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNumerical Variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumerical Variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003emedian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003emin.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003emax.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of child (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of mother (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime to first breastfeeding (minutes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e43,200\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. of daytime feedings, first 6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. of nighttime feedings, first 6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal time breastfeeding (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1275\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlanned time breastfeeding (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows categorical data for mothers and children. A total of 17% of the mothers received gifts in the hospital, with the most frequent being infant formula (70%) and bottles and pacifiers (11.8%); the rest did not recall what they had received. Of the children, 54 were boys, 60% had a heart disease, 29% had a gastrointestinal disorder (of whom 34% required surgical intervention), 90% had a high-arched palate, 38% had problems with sucking, and 18% had problems with swallowing.\u003c/p\u003e \n\u003cp\u003eTable 2. Categorical Variables for Mothers and Children\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"330\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.51963746223565%\" valign=\"top\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.48036253776435%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.51963746223565%\" valign=\"top\"\u003e\n \u003cp\u003eMother\u0026rsquo;s Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.48036253776435%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.51963746223565%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Undergraduate or graduate degree\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;High school\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Junior high school\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Elementary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.48036253776435%\" valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.51963746223565%\" valign=\"top\"\u003e\n \u003cp\u003eGifts in hospital\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.48036253776435%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.51963746223565%\" valign=\"top\"\u003e\n \u003cp\u003eChild\u0026rsquo;s Sex\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Male\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.48036253776435%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.51963746223565%\" valign=\"top\"\u003e\n \u003cp\u003eChild with heart disease\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.48036253776435%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.51963746223565%\" valign=\"top\"\u003e\n \u003cp\u003eChild with digestive disorders\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Major disorders\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Minor disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.48036253776435%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.51963746223565%\" valign=\"top\"\u003e\n \u003cp\u003eHigh-arched palate\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.48036253776435%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.51963746223565%\" valign=\"top\"\u003e\n \u003cp\u003eProblems with sucking\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.48036253776435%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.51963746223565%\" valign=\"top\"\u003e\n \u003cp\u003eProblems with swallowing\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.48036253776435%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e \u003cp\u003eData on children\u0026rsquo;s feeding are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. A total of 98 children received mother\u0026rsquo;s milk at least once, either directly from the mother or by other means. Among those who were hospitalized during their first days of life, 64 received infant formula during their first 3 days, some in combination with mother\u0026rsquo;s milk and others exclusively. Once at home, 90 children were fed on demand, 52 mothers used a bottle with mother\u0026rsquo;s milk (the majority of these frequently), and 65 used infant formula. Mothers\u0026rsquo; responses to questions about technique during breastfeeding (position of mother and baby, pain, clicking sounds) and afterwards (number of diapers, crying after feeding) indicated that up to 36% had a faulty technique.\u003c/p\u003e \u003cp\u003eTable 3. Data on Feeding\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"399\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"91.97994987468671%\" valign=\"top\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.020050125313283%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"91.97994987468671%\" valign=\"top\"\u003e\n \u003cp\u003eEver breastfed\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.020050125313283%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;2\u003c/p\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"91.97994987468671%\" valign=\"top\"\u003e\n \u003cp\u003eInfant formula in first 3 days\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.020050125313283%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"91.97994987468671%\" valign=\"top\"\u003e\n \u003cp\u003eFeeding on demand\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.020050125313283%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"91.97994987468671%\" valign=\"top\"\u003e\n \u003cp\u003eUse of bottle with mother\u0026rsquo;s milk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.020050125313283%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"91.97994987468671%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Attempted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.020050125313283%\" valign=\"top\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"91.97994987468671%\" valign=\"top\"\u003e\n \u003cp\u003eFeeding at home with infant formula\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.020050125313283%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"91.97994987468671%\" valign=\"top\"\u003e\n \u003cp\u003eReason for feeding with infant formula\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Mother\u0026rsquo;s decision\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Low milk supply\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.020050125313283%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"91.97994987468671%\" valign=\"top\"\u003e\n \u003cp\u003eProper breastfeeding technique\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.020050125313283%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"91.97994987468671%\" valign=\"top\"\u003e\n \u003cp\u003eBreastfeeding continued through date of interview\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.020050125313283%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e \u003cp\u003eThe factors associated with a baby being exclusively breastfed were analyzed. There were 74 babies who were at least 6 months old at the time of the interview. Of these, 24 (32%) were exclusively breastfed. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the significant associations in a bivariate analysis: babies with the greatest probability of being exclusively breastfed were those without problems with sucking or swallowing, whose mothers used proper breastfeeding technique, who were fed on demand, and whose mothers were youngest.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBivariate Analysis of Babies Exclusively Breastfed for 6 Months\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProblems with sucking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (83.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e˂0.001 \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProblems with swallowing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (91.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.038 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProper technique\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e˂0.001 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFeeding on demand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (84%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.048 **\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother\u0026rsquo;s age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.068 ***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e* Pearson\u0026rsquo;s Χ\u003csup\u003e2\u003c/sup\u003e. ** Fisher\u0026rsquo;s exact test. *** Mann-Whitney \u003cem\u003eU\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA multivariate logistic regression analysis (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) found that the only significant variables were sucking and mother\u0026rsquo;s age, both with a negative B coefficient, indicating that the probability of exclusive breastfeeding was higher in the absence of sucking problems and with mothers who were younger. A Hosmer-Lemeshow test showed that the model was good.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic Regression Analysis of Babies Exclusively Breastfed for 6 Months.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI OR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProblems with sucking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.408\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother\u0026rsquo;s age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.913\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.847\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.983\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.917\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCI: confidence interval; OR: odds ratio.\u003c/p\u003e \u003cp\u003ePatients were subsequently evaluated who had completed a minimum of 12 months of breastfeeding (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;62). Of these, 30.6% continued breastfeeding with complementary feeding. The results (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e) show that the variables associated with continued breastfeeding at one year were the absence of problems with sucking, proper breastfeeding technique, and mothers who were younger. A logistic regression analysis (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e) produced results similar to the previous one: the significant variables were sucking and mother\u0026rsquo;s age.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBivariate Analysis of Breastfeeding for 12 Months.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProblems with sucking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (10.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (62.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (89.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (37.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e˂0.001 \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProper technique\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (39.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (60.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e˂0.001 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother\u0026rsquo;s age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.085 **\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e* Pearson\u0026rsquo;s Χ\u003csup\u003e2\u003c/sup\u003e. ** Mann-Whitney \u003cem\u003eU\u003c/em\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic Regression Analysis of Breastfeeding for Twelve Months.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProblems with sucking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-3.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.255\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother\u0026rsquo;s age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.820\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.985\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.554\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.954\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCI: confidence interval; OR: odds ratio.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eBreastfeeding is an important public health measure in every country. It is the first tool we have for ensuring people\u0026rsquo;s health, providing for adequate nutrition, proper development, and a reduction in infectious diseases and their complications [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The proportion of babies in this study who were breastfed, irrespective of technique or whether breastfeeding continued, was 98%, similar to that reported in Chile (95.9%), Brazil (84.2%), the United Kingdom (92.5%), the United States (92.5%), and Puerto Rico (84.3%), but different from countries such as New Zealand, Croatia, and Italy, where fewer than 50% of babies with DS are breastfed [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In these countries, babies born with DS have a lower probability of being breastfed, and the proportion is even lower if they have a heart disease.\u003c/p\u003e \u003cp\u003eIn Mexico, most mothers try to breastfeed, which is clearly a good starting point, but we found that only 29% continued breastfeeding complemented with other nutrition at the age of 12 months. The rest did not receive the benefits of improved nutrition, digestion, lipids promoting neurodevelopment, or protection against infection during their first year of life, which is when they tend to have a greater number of respiratory and gastrointestinal infections. Of the children in this study, 71% did not receive the minimum necessary breastfeeding time recommended by the WHO.\u003c/p\u003e \u003cp\u003eSome of the most important measures recommended by the WHO for successful breastfeeding are to respect the \u0026ldquo;golden hour,\u0026rdquo; when mother and baby have skin-to-skin contact and the baby is offered milk during the first 40 minutes of life, to have the baby in the same room as the mother, to breastfeed on demand from birth, to provide information and ensure that mothers use proper technique, and not to offer any gifts in the hospital related to feeding that do not support breastfeeding. Most participants in our study had their first feeding 4 hours after birth, with infant formula for the first and some subsequent feedings. Among the mothers in our study, 17% had received a gift related to feeding, and 70% of those gifts were infant formula. Colon et al., in a study in Puerto Rico, found that 50% of mothers were not given their babies while they were in the hospital, whether they were healthy or not [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhere babies did not breastfeed successfully, it was in many cases because their mothers did not use proper technique, generally for lack of information. We found that failure to breastfeed on demand in the first 6 months is a risk factor for not breastfeeding throughout that period. During the first 6 months, 67.6% of mothers in our study used infant formula, either exclusively or in conjunction with breastfeeding. This figure is alarming, and a marked contrast with countries like Chile, where only 23.3% use exclusively formula [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Improving these figures requires developing public policy in hospitals, with ongoing training so that health personnel are well informed and can ensure that mothers have fully understood the technique and advantages of breastfeeding before they leave the hospital with their babies.\u003c/p\u003e \u003cp\u003eAmong the factors related to the baby, we found, as expected, that problems with sucking or swallowing were important risk factors, but were not related to other comorbidities, such as heart disease or gastrointestinal disorders.\u003c/p\u003e \u003cp\u003eAn interesting finding in our study was that the younger the mother, the greater the possibility was that the baby would successfully breastfeed for a longer period of time. This is in contrast to data from the ENSANUT, where the majority of babies breastfeeding for at least two years had mothers aged 20\u0026ndash;59 years [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn Mexico, breastfeeding continues to be an area of concern, requiring further effort both with health care workers and with families. Breastfeeding is abandoned more often than it should be, often on medical instructions or for lack of information for mothers \u0026nbsp; \u0026nbsp; . In the case of babies with DS, there are multiple factors that may interfere with successful breastfeeding. The most important of these is problems with sucking, but there are other variables that can be addressed, such as education of mothers in proper technique and feeding on demand.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompliance with Ethical Standards\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was approved by the Research and Research Ethics Boards of the National Institute of Pediatrics, Mexico City, (Approval No. 2022/031; IRB00008064 and IRB00008065, NIH Office for Human Research Protections, http://ohrp.cit.nih.gov/search/search.aspx), according to the principles of the Helsinki Declaration. A copy of the approvals is available upon request. The study was considered to be of minimal risk, as it consisted only of a survey of mothers about breastfeeding, without risk to the life or functioning of the participants. Interviews were performed at no cost. Written informed consent was obtained from parents or guardians. The informed consent process and the objectives of the study were explained to the mothers and their questions were answered. It was explained that the decision to participate or not to participate would not affect the care they received. Names and other personal information not relevant to the study were not used, and all information collected was securely stored by the researchers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work received financial support from the Instituto Nacional de Pediatría (Project No. 2022/031).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article and its supplementary information files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Conceptualization and data curation were performed by Karla Adney Flores Arizmendi, research was carried out by Alejandra Ochoa Rodríguez, data were analyzed by Silvestre García de la Puente, and the manuscript was written, reviewed, and edited by Silvestre García de la Puente, Alejandra Ochoa Rodríguez and Tania Tonantzin Vargas Robledo. The first draft of the manuscript was written by Silvestre García de la Puente and Alejandra Ochoa Rodríguez. All authors read and approved the final manuscript. \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLagan N, Huggard, D, Mc Grane F, Leahy TR, Franklin O, Roche E, et al. Multiorgan involvement and management in children with Down syndrome. Acta Paediatrica. 2020;109(6):1096\u0026ndash;1111. DOI:10.1111/apa.15153.\u003c/li\u003e\n\u003cli\u003eShukla D, Bablani D, Chowdhry A, Thapar R, Gupta P, Mishra S. Dentofacial and cranial changes in Down syndrome. Osong Public Health Res Perspect. 2014 5(6):339-44. DOI: 10.1016/j.phrp.2014.09.004.\u003c/li\u003e\n\u003cli\u003eAgostini, CO, Poloni, S., Barbiero, SM, Vian, I. Prevalence of breastfeeding in children with congenital heart diseases and Down syndrome. Clin Nutr ESPEN. 2021; 44:458-462. doi: 10.1016/j.clnesp.2021.03.023.\u003c/li\u003e\n\u003cli\u003eBrahm P, Valdés V. Beneficios de la lactancia materna y riesgos de no amamantar. Rev Chil Pediatr. 2017;88(1): 7-14. DOI: 10.4067/S0370-410620170001000001\u003c/li\u003e\n\u003cli\u003eWho.int. Breastfeeding . https://www.who.int/es/health-topics/breastfeeding#tab=tab_2. Consulted 1 Abril 2022.\u003c/li\u003e\n\u003cli\u003eMagenis ML, de Faveri W, Castro K, Forte GC, Grande AJ, Perry IS. Down syndrome and breastfeeding: A systematic review. J Intellect Disabil. 2020; 25: 1-20. doi: 10.1177/1744629520970078.\u003c/li\u003e\n\u003cli\u003eINEGI. Lactancia materna y pr\u0026aacute;cticas de alimentaci\u0026oacute;n complementaria (0 a 36 meses). https:www.inegi.org.mx/contenidos/programas/Ensanut/2018/doc/ensanut 2018 lactancia materna practicas alimentaci\u0026oacute;n.pdf,. Consulted 29 June 2024.\u003c/li\u003e\n\u003cli\u003eBinns C, Lee M, Low WY. The Long-Term Public Health Benefits of Breastfeeding. Asia Pac J Public Health. 2016 Jan;28(1):7-14. doi: 10.1177/1010539515624964.\u003c/li\u003e\n\u003cli\u003eCol\u0026oacute;n E, D\u0026aacute;vila-Torres RR, Parrilla-Rodr\u0026iacute;guez AM, Toledo A, Gorr\u0026iacute;n-Peralta JJ, Reyes-Ortiz VE. Exploratory study: barriers for initiation and/or discontinuation of breastfeeding in mothers of children with Down syndrome. P R Health Sci J. 2009; 28(4):340-4. PMID: 19999242.\u003c/li\u003e\n\u003cli\u003eSánchez-Pérez A, Velázquez-Lerma R, Díaz-Vargas P, Molina Nava MCD. Práctica de la lactancia materna en México. Análisis con datos de la Encuesta Nacional de la Dinámica Demográfica (ENADID) 2014. Real datos y Espac Rev Int Estadística y Geogr. 2019;10(1):4-17.\u003c/li\u003e\n\u003cli\u003eNIH Office for Human Research Protection. http://ohrp.cit.nih.gov/search/search.aspx. Consulted 7 April 2024.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Down Syndrome, breastfeeding, risk factors","lastPublishedDoi":"10.21203/rs.3.rs-4413101/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4413101/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction. Babies with Down syndrome (DS) present physical characteristics that can make breastfeeding difficult, including hypotonia of the muscles of the oral cavity and pharynx which can create problems with sucking and swallowing. Breastfeeding has proven beneficial for babies, and it is recommended to be exclusive for the first 6 months. However, babies born with DS have a higher probability of not being breastfed.\u003c/p\u003e \u003cp\u003eObjective. Describe the frequency and characteristics of breastfeeding in children with DS at the National Institute of Pediatrics, Mexico City.\u003c/p\u003e \u003cp\u003eMaterials and Methods. This was an observational, descriptive, prospective, and cross-sectional study with 100 mothers concerning their breastfeeding experience, using the 2019 ENSANUT questionnaire. The analysis was performed with descriptive statistics.\u003c/p\u003e \u003cp\u003eResults. The mothers reported that 98% of their babies had received mother\u0026rsquo;s milk at least once and that 64% had received infant formula in the first three days of life. The median duration of breastfeeding was three months; 32.4% of the babies were exclusively breastfed for 6 months. Risk factors for not being breastfed were problems with sucking, swallowing, and not providing feeding on demand, as well as improper technique.\u003c/p\u003e \u003cp\u003eConclusions. Only 32% of babies were exclusively breastfed, for various reasons.\u003c/p\u003e","manuscriptTitle":"Breastfeeding in Children with Down Syndrome","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-31 04:42:29","doi":"10.21203/rs.3.rs-4413101/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-06-26T03:59:25+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-24T19:27:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-19T00:02:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-18T21:31:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-07T14:00:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"10874185613454511075964829112253525090","date":"2024-06-06T23:24:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"335870475452251624670541242234771291981","date":"2024-06-04T07:17:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"89150344946261596268814194499792005755","date":"2024-06-03T23:40:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"330401578178466985521292860042369639748","date":"2024-06-03T17:48:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"204400127448368877809064750086629498588","date":"2024-06-03T16:21:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-03T14:56:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-20T13:00:43+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-05-20T12:37:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-20T12:35:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2024-05-13T12:05:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fbf1a0ed-0141-4bad-9388-16dc9a9b3c70","owner":[],"postedDate":"May 31st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-06-02T16:06:38+00:00","versionOfRecord":{"articleIdentity":"rs-4413101","link":"https://doi.org/10.1186/s12887-024-05363-0","journal":{"identity":"bmc-pediatrics","isVorOnly":false,"title":"BMC Pediatrics"},"publishedOn":"2025-05-31 15:57:53","publishedOnDateReadable":"May 31st, 2025"},"versionCreatedAt":"2024-05-31 04:42:29","video":"","vorDoi":"10.1186/s12887-024-05363-0","vorDoiUrl":"https://doi.org/10.1186/s12887-024-05363-0","workflowStages":[]},"version":"v1","identity":"rs-4413101","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4413101","identity":"rs-4413101","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}