ASSESS THE BREASTFEEDING PRACTICES OF MOTHERS AND THUMB SUCKING HABITS OF CHILDREN IN SELECTED ANGENVADIES UNDER CHALAKUDY MUNICIPALITY, THRISSUR,

Mrs. Aparna Paul. M.Sc in Child Health Nursing, Lecturer, St. Johns College Of Nursing, Koramangala, Bangalore. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 10 May 2019 Final Accepted: 12 June 2019 Published: July 2019

Breastfeeding is the normal way of providing young infants with the nutrients that they need for healthy growth and development. Thumb sucking is a habit which can be seen in children. The literature review provides the information that the thumb sucking habit of the children is associated with the breastfeeding practices of the mothers. A study was conducted to assess the breastfeeding practices of mothers and thumb sucking habits of children in selected angenvadies under Chalakudy Municipality, Thrissur, Kerala. A quantitative nonexperimental research approach and descriptive correlation design was used for this study. Objectives of the study were (i) To assess the breastfeeding practices of mothers. (ii) To assess the thumb sucking habits of children (iii) To assess the association between breastfeeding practices of mothers and thumb sucking habits of children.100 children between 2-6 years and their mothers were selected as subjects by using cluster sampling method. Data was gathered by using questionnaire and rating scale. Data analysis was done by descriptive and inferential statistics. Frequency and percentage was used to present the data. Fisher's exact test was used to find the association between the variables. The result showed that exclusive, predominant and demand breastfeeding percentage was 82%, 18% and13% respectively. Complimentary breastfeeding percentage was 17%, 67%, and 16% by the 4th, 6th and 8th month respectively. There is an association between exclusive (Fisher's exact value was 16.565), predominant (Fisher's exact value was 8.135) and complimentary (Fisher's exact value was 8.487) breastfeeding practices of mothers with thumb sucking habits of children and no association found between demand(Fisher's exact value was 1.713) breastfeeding and thumb sucking habit.

ISSN: 2320-5407
Int. J. Adv. Res. 7(7), 404-408 405 infective factors which protect the baby. The natural immunizing factor present in the breast milk gives the child the necessary fight strength to deadly diseases like diarrhoea, respiratory problems, asthma, and allergies. Research conducted worldwide indicates that children who are not on breast milk are twenty five times more susceptible to disease. 1 As a global public health recommendation exclusive breastfeeding should be practiced for the six months of life to achieve optimum growth and health. Government has launched several measures to promote the exclusive breastfeeding at national level including baby friendly hospital initiative [BFHI]. 2 Exclusively breastfed babies grow rapidly in initial stages and then may slow down normally about 3 or 4 months which is called as faltering. Exclusive breastfeeding should be continued in such babies for about 6 months. 3 UNICEF says that despite compelling evidence that exclusive breastfeeding prevents diarrhoea and pneumonia, global rates of breastfeeding have relatively stagnant in developing world growing from 32% in 1995 to 39% in 2010. If breast feeding was promoted more effectively, survival rates of children will be improved. Proper breastfeeding exercise could lower the rates of disease, malnutrition, stunting and reduces the mortality rate. It prevents millions of deaths every year. A recent lancet study also highlighted the fact that non breastfed children are 14 times likelier to die in the first six months than exclusively breastfed children. 4 UNICEF estimates percentage of newborns put to breast within one hour of birth 2006-2010 in worldwide includes , Eastern and Southern Africa 54%, Middle East and North Africa 45%, East Asia and Pacific 45% , Latin America and Caribbean 42% ,West and Central Africa 39% South Asia 39% and in developing world 43%. The percentage of infants under the age of six months who are exclusively breastfed during 2006-2010 across regions includes Eastern and Southern Africa 49%, South Asia 45%, Latin America and Caribbean 42%, Middle East and North Africa 34%, East Asia and Pacific 29%, and West and Central Africa 24%. Average key feeding indicators in the developing world estimates that early initiation of breastfeeding (1 hour of birth), exclusive breastfeeding (0-5months), introduction of solid foods (6-8 months), continued breastfeeding (1year) and continued breastfeeding after (2years) were 43%,37%,60%,75%and56% respectively 5 In India, as per National Family Health Survey (NFHS) 2005-2006 statistics estimates that Exclusive breastfeeding was 46% up to five months, during six to eight months 57% were introduced to solid food, 88% continued breastfeeding during twelve to fifteen months and 77% still continued breast feeding up to twenty three months. Kerala has been placed in 6th position for the initiation of breastfeeding within 1 hour by ranking of states of India [55.6%]. 6

Methodology:-
A quantitative, non-experimental evaluatory approach was considered in this study.The research design was non experimental, descriptive correlational design. Breastfeeding practices such as exclusive breastfeeding, predominant breastfeeding, demand breastfeeding, and complimentary breastfeeding were considered to be the independent variables.
Dependent variables referred to the thumb sucking habits of children. study was conducted in selected angenvadies, under Chalakudy Municipality, at Thrissur District. Chalakudy Municipality consisted of thirty seven angenvadies with 400 children. Among these eighteen angenvadies were selected for this study.The population in this study included all children between 2 to 6 years of age and their mothers in the angenvadies under Chalakudy Municipality. The samples included in this study were 100 children between 2 to 6 years of age and their mothers in the angenvadies under chalakudy municipality. A cluster sampling technique was used to select the 100 children and their mothers from the angenvadies according to the inclusion criteria Such as Children between 2 to 6 years of age and their mothers, Children who were present at the time of study, Mothers who were willing to participate in the study, Mothers who read Malayalam. Instruments developed for the present study were structured questionnaire and rating scale to assess the breastfeeding practices of mothers and thumb sucking habits of their children 406

Results:-
The major findings of demographical data showed that among 100 mothers 48(48%) were 26-30 years of age and 71(71%) had 2 children. The demographic data of the children showed that 43(43%) children were with 3 -4 years and 53(53%) belonged to the second ordinal position.
It was evident that exact half percentage of subjects 50(50%) got education regarding breastfeeding prior to delivery. 81(81%) mothers breastfed their children within 1 hour after delivery. More significantly, 98(98%) mothers continued breastfeeding after 6 months. 16(16%) mothers reported that lack of breast milk was the main reason to start other food items along with breastfeeding to the child before 6 months.12 (12%) mothers practiced bottle feeding. 7(7%), 6(6%), 31(31%), 8(8%), 9(9%), 1(1%) and 1(1%) mothers reported that the breastfeeding was given to their children up to one year, one and half years, two years, two and half years , three years, three and half years, ten months and nine months respectively. 99 (99%) mothers did not face any problem for breastfeeding to their children. Similarly 97(97%) children did not experience any problem for suckling.
A five point likert scale was used to assess the breastfeeding practices of mothers and thumb sucking habits of their children. Analysis revealed that 52(52%) mothers had breast preparation always during antenatal period. 63(63%) mothers did not follow 'latch on' technique during breastfeeding their children as well as 75(75%) mothers did not use their both breast alternatively for breastfeeding. 92(92%) mothers did not use pacifier for their children. To continue the exclusive breastfeeding only 2(2%) mothers got family support. The reports of mothers revealed that 13(13%) children only always cried for breastfeeding in 3 hours of interval and only 2(2%) children had frequent suckling always during breastfeeding.
In the present study 24(24%) children had thumb sucking habit. Among those 24 children 13(54.2%) children had the thumb sucking frequently and 7(29.2%) rarely sucked their thumb when felt hungry. Minimum number of children 3(3%) had thumb sucking during sleep always, some times and most of the time. Negligible number of children had thumb sucking when they were alone 3(12.5%). It was reported that only 1(4.2%) child sucked her thumb when felt insecure. 2(8.33%) children had the habit of thumb sucking during emotional disturbances and stress.
The association between breastfeeding practices of mothers and thumb sucking habits of children such as exclusive breastfeeding, predominant breastfeeding and complimentary breastfeeding and thumb sucking habits of children revealed that the p -value was less than the significant value at 0.05 levels and the Fisher's exact test was significant. In contrary, the association between demand breastfeeding practices of mothers and thumb sucking habits of children showed that the Fisher's exact value was 1.713 with p -value (0.293).
The Result of association between the selected demographical variables of mothers and breastfeeding practices showed that there was no association among education, occupation and number of children of mothers with exclusive breast feeding, predominant breastfeeding demand breastfeeding practice. The analysis indicated that there was no association among age, sex and ordinal position of the children with their thumb sucking habit.

Discussion:-
Current study results showed that greater part of the subjects 82(82%) practised exclusive breastfeeding. Predominant breastfeeding was practised by 18(18%) mothers. Majority of mothers (87%) did not follow demand breastfeeding. Regarding complimentary breastfeeding, 67(67%), 17(17%) and 16(16%) mothers started complimentary breastfeeding by 6th month, 4th month and 8th month respectively. A similar study supported the present study which was conducted in Brazil among 100 mothers revealed that 75(75%) mothers have breastfed their children. Among these 20%, 21%, 34% and 25% of mothers have done exclusive, predominant, complementary breastfeeding practices and weaning to their children respectively. 8

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In the present study, the mothers reported that most of them faced lack of breast milk for exclusively breastfeeding their children. This was the main reason to start complimentary feedings. A longitudinal study on breastfeeding and weaning practices during the first year of life was conducted among breastfeeding mothers in 2002 was given a similar result to the present study that the mothers faced lack of breast milk in order to exclusively breastfeed their children. 9 A study conducted in India on 2004 among 8000 mothers from both rural and urban areas of two villages revealed the same result as the present study that the main reason for starting complimentary feeds was mother's insufficient breast milk and increasing child demand. 10 The present study showed that among 100 children, 24(24%) children had the thumb sucking habits. A study with an aim to assess the breastfeeding pattern and the influence of non sucking habits portrays that 55(55%) children had the thumb sucking habit among 100 children and suggested that breastfeeding can prevent thumb sucking habit. 7 A study conducted in 2006 to evaluate the association of history of breastfeeding and incidence of malocclusion among 540 children depicts 32% significant differences were identified between malocclusion and thumb sucking. 47 While assessing the thumb sucking habit among 24 children, 13 children had the thumb sucking frequently. 5, 3, 7 and 1 children had the thumb sucking habit rarely during sleep, when they were alone, during hungry feeling and insecurity periods respectively. 22% of children never had the habit of thumb sucking even during emotional disturbance, stress and bored. The text book literature showed that psychological and habitual effects can leads to abnormal thumb sucking among children. The habit may have a deep rooted emotional factor involved and may be associated with insecurities, neglect, loneliness experienced by the child results in thumb sucking. 11 The association between breastfeeding practices of mothers and thumb sucking habits of children in the present study revealed that exclusive, predominant, complimentary breastfeeding practices of mothers were dependent and there was an association between these three specific breastfeeding aspects with the thumb sucking habit of children. Only the demand breastfeeding showed a contrary report that it did not have any association with thumb sucking habit of their children. A similar result in a retrospective (2004) study on effect of the type of feeding and non nutritive sucking activity on occlusion in deciduous dentition among 1130 preschoolers revealed that the type of feeding was associated with the thumb sucking habits of children. 12 The current study revealed that among the selected demographical variables of the subjects, there was no association between education, occupation and number of children of mothers with exclusive breast feeding, predominant breastfeeding demand breastfeeding practice. Eventhough the education and number of children of mothers showed no association with thumb sucking habit of children, the occupation implied the association between the mother's occupation and complimentary breastfeeding practice. A study conducted among 506 mother infant pairs to analyze the influence of thumb sucking and breastfeeding patterns revealed that only maternal age, education had an association with breastfeeding practice of mothers. 51 A similar Brazilian study among 100 mothers revealed the association between marital status of mother and breastfeeding practices. 8

Conclusion:-
The different practices of breastfeeding were present among mothers in the society as well as the prevalence of thumb sucking habits among the children was also evident. Generally breastfed children are less likely to suck their thumbs because breastfeeding usually satisfies the child's needs to suck. If the child's sucking need is not satisfied by exclusive breastfeeding, the occurrence of thumb sucking is more evident and this leads to health problems like appearance, speech, chewing and malocclusions. In order to prevent these problems the exclusive breastfeeding should be encouraged. The present study to assess the breastfeeding practices of mothers and thumb sucking habits of children revealed that there is an association between these variables. Specifically; exclusive, predominant and complimentary breastfeeding practices were associated with thumb sucking habits of children and demand breastfeeding showed no association. Accomplishing this study was an enthusiastic experience for the researcher to build self confidence in taking up further research studies. This study has given an insight for researcher regarding the association between breastfeeding practices of mothers and thumb sucking habits of children. Today's children are the tomorrow's citizens. It is our duty to protect the health of children and prevent the diseases and deformities among them. Thereby the nation can create a healthy environment. This study recommends the need to strengthen the awareness programmes on breastfeeding practices among mothers and its association between thumb sucking habits of their children.