doi:10.1111/jpc.
13873
HEADS UP
edited by Craig Mellis (craig.mellis@sydney.edu.au)
Prolonged breastfeeding and dental caries
There is low level evidence that breastfeeding for over a year
may be associated with dental caries (Fig. 1). The parents of
babies enrolled in a birth cohort study from Brazil were offered
to participate in a study of oral health.1 Information was collected
prospectively on breastfeeding and sugar consumption. The main
outcomes were the number of decayed, missing and filled pri-
mary teeth (dmft) at the age of 5 years. Severe early childhood
caries was defined as dmft of 6 or more. Marginal structural
modelling was used to correct for confounding factors in estimat-
ing the direct effect of breastfeeding on severe caries. Despite
public fluoridated water supply, the prevalence of severe caries
was 24% and the mean dmft was 4.05. Children breastfed for
24 months or longer had a greater dmft than children breastfed
for 12 months or less (mean ratio = 1.9; 95% confidence interval
1.5–2.4) and more than twice the risk of severe caries (risk
ratio = 2.4; 95% confidence interval 1.7–3.3). This association
Fig. 1 The Virgin and Child by Giovanni Antonio Boltraffio (1467–1516).
Journal of Paediatrics and Child Health 54 (2018) 333–334
© 2018 Paediatrics and Child Health Division (The Royal Australasian College of Physicians)
was independent of sugar consumption. Babies breastfed for
13–23 months did not have an increased risk of dental caries.
Paediatricians may feel these data should be communicated to
mothers contemplating or engaging in breastfeeding beyond their
child’s second birthday.
Reference
1 Peres KG et al. Pediatrics 2017; 140: e20162943.
Reviewers: David Isaacs, david.isaacs@health.nsw.gov.au; Richard Widmer,
Children’s Hospital at Westmead, Sydney
Migraine and cognitive behavioural therapy
Recurrent abdominal pain is one of the classic childhood ‘psycho-
somatic’ diseases, in that most children have no discernible
organic cause and there is a strong placebo effect associated with
treatment trials. A high proportion of these children later develop
migraine, and migraine trials are also prone to a strong placebo
effect.1 A meta-analysis of randomised controlled trials of cogni-
tive behaviour therapy (CBT) for migraine found 14 trials which
compared CBT with waiting-list control children, placebo or anti-
migraine medication.2 Treatment could not be blinded to the
child or parents. The end-point was a reduction by at least 50%
in headache. Children given CBT were over nine times more
likely to achieve a 50% (or greater) reduction in headache fre-
quency than controls, both at the end of treatment (odds ratio =
9.1, 95% confidence interval 5.0–16.6) and 3 months later (odds
ratio 9.12, 95% confidence interval 5.7–14.8). The improvement
lasted as long as 12 months in the three studies which followed
subjects for that duration. The availability and cost of CBT are
potentially problematic, but in view of the high incidence and
morbidity of childhood migraine, many parents would probably
be interested in knowing that CBT works better than
medications.
References
1 Isaacs D. J. Paediatr. Child Health 2018; 54: 102.
2 Ng QX et al. Headache 2017; 57: 349–62.
Reviewer: David Isaacs, david.isaacs@health.nsw.gov.au, Children’s Hospital
at Westmead, Sydney
Influenza vaccine saves children’s lives
Although we know that some of our patients are at increased risk
of severe influenza, we are not very good at immunising them. A
large case–control study shows that we are putting their lives at
risk by not doing so.1 The authors found 358 US children aged
333