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Educacin Mdica Continua SAVAL Dr.

Francisco Moraga
Formacin de competencias en pediatra
SOCHIPE 2015

Problemas frecuentes en el
control peditrico:
Mitos y Verdades

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Educacin Mdica Continua SAVAL Dr. Francisco Moraga
Formacin de competencias en pediatra
SOCHIPE 2015

Lineamientos de la presentacin

1. Definiciones

2. Desmitificando creencias frecuentes por edad

3. Reflexiones sobre crianza positiva

4. Conclusiones

El gran enemigo de la verdad a menudo no es la mentira deliberada,


tendenciosa y deshonesta sino el mito persistente, persuasivo e
ilusorio.
John F. Kennedy

El mito pertenece al orden de las creencias y que si bien es una


explicacin, no es una explicacin racional, sino cultural.
Bronislaw Malinowski

No son historias alejadas de la persona, sino que funcionan como


un asidero existencial, un motivo.
Rollo May

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Educacin Mdica Continua SAVAL Dr. Francisco Moraga
Formacin de competencias en pediatra
SOCHIPE 2015

Dentro del campo de la Pediatra, muchas costumbres se han


arraigado en el medio familiar y siguen transmitindose de generacin
en generacin, siendo aceptadas sin objecin alguna.

Son los llamados mitos, supersticiones, cuentos, fbulas, invenciones,


etc., que constituyen hechos muy comunes del quehacer mdico
infantil cotidiano, pero que, bajo una apariencia lgica, esconden
graves errores.

Tambin se los ha calificado como costumbres seudocientficas,


basadas, la mayor parte de las veces, en hechos reales, que no
han sido estudiados con rigor y profundidad y que han pasado a la
categora de dogmas, permitiendo de esta manera que se emitan
diagnsticos incorrectos, que se apliquen medidas errneas y que se
"receten" remedios inadecuados, ocasionando as graves perjuicios a
la salud.

Fontanarrosa y los Mdicos.


1987. Ed. de la Flor. Bs. As., Argentina.

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Educacin Mdica Continua SAVAL Dr. Francisco Moraga
Formacin de competencias en pediatra
SOCHIPE 2015

MITO # 1
La madre que est dando pecho no puede comer
cebollas, ajos, repollo o chocolate....tabaco.

Infantile colic: a systematic review of medical and conventional therapies.


J Paediatr Child Health 2012; 48(2):128-37.

Dietary management of infantile colic: a systematic review.


Matern Child Health J 2012; 16(6):1319-31.

Treating infant colic with the probiotic Lactobacillus reuteri: double blind, placebo controlled randomised trial.
BMJ. 2014; 348:g2107.

Infantile colic: practicalities of management, including dietary aspects.


J Fam Health Care.2010; 20(6):206-9.

Complementary, holistic, and integrative medicine: colic.


Pediatr Rev 2007; 28(10):381-5.

Intrinsic and extrinsic influences on children's acceptance of new foods.


Physiol Behav 2013; 121:89-95.

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Educacin Mdica Continua SAVAL Dr. Francisco Moraga
Formacin de competencias en pediatra
SOCHIPE 2015

Morphological and biological effects of maternal exposure to tobacco smoke on the feto-
placental unit. Early Hum Dev 2007; 83(11):699-706. University of Cambridge, UK

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Educacin Mdica Continua SAVAL Dr. Francisco Moraga
Formacin de competencias en pediatra
SOCHIPE 2015

Nicotine exposure in breastfed infants.


Acta Paediatr 2004; 93(6):810-6.

Votavova H, et al. Transcriptome alterations in maternal and fetal cells induced by


tobacco smoke. Placenta 2011; 32(10):763-70.

Demirhan O et al. The genotoxic effect of nicotine on chromosomes of human fetal


cells: the first report described as an important study. Inhal Toxicol 2011; 23(13):829-34.

MITO # 2
Algunas madres tienen la leche ms delgada o
dbil

Human milk composition: nutrients and bioactive factors.


Pediatr Clin North Am 2013; 60(1):49-74.

Community influences on breast feeding.


Child Care Health Dev. 1980 May-Jun;6(3):175-87.

Disparity between paediatricians' knowledge and practices regarding breastfeeding.


Acta Paediatr. 2007 Nov;96(11):1712-3.

Breast milk as the gold standard for protective nutrients.


J Pediatr 2010;156(2 Suppl):S3-7.

Physiological aspects of human milk lipids and implications for infant feeding: a workshop report.
Acta Paediatr 2011; 100(11):1405-15.

Effect of breastfeeding compared with formula feeding on infant body composition: a systematic review
and meta-analysis.
Am J Clin Nutr 2012; 95(3):656-69.

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Educacin Mdica Continua SAVAL Dr. Francisco Moraga
Formacin de competencias en pediatra
SOCHIPE 2015

MITO # 3
El Hierro y la alimentacin no lctea causan
constipacin (estreimiento)

Iron-fortified formulas and gastrointestinal symptoms in infants: a controlled study, With the
cooperation of The Syracuse Consortium for Pediatric Clinical Studies.
Pediatrics. 1980 Aug;66(2):168-70.

Formula tolerance in postbreastfed and exclusively formula-fed infants.


Pediatrics. 1999 Jan;103(1):E7.

Clinical safety of iron-fortified formulas.


Pediatrics. 2000 Mar;105(3):E38.

Zinc and iron nutrition in Chilean children fed fortified milk provided by the Complementary
National Food Program.
Nutrition. 2004 Feb;20(2):177-80.

Side effects of oral iron prophylaxis in pregnancy--myth or reality?


Acta Haematol. 2006;115(1-2):53-7.

Characteristics of Intestinal Habits In Children Under Four Years of Age: Detecting Constipation.
J Pediatr Gastroenterol Nutr.2012 Feb 29. [Epub ahead of print]

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Educacin Mdica Continua SAVAL Dr. Francisco Moraga
Formacin de competencias en pediatra
SOCHIPE 2015

MITO # 4
Hay que impedir el uso del chupete de
entretencin ya que es nocivo para la salud.

A randomized controlled trial of sucrose and/or pacifier as analgesia for infants receiving
venipuncture in a pediatric emergency department.
BMC Pediatr. 2007 Jul 18;7:27.

Sudden infant death syndrome: another year of new hope but no cure.
Curr Opin Pulm Med. 2007 Nov;13(6):497-504.

Pacifiers: an update on use and misuse.


J Spec Pediatr Nurs. 2007 Oct;12(4):278-85.

Pacifier use is associated with a reduced risk for sudden infant death.
J Pediatr. 2006 Mar;148(3):416

Occlusal and orofacial myofunctional evaluation in children with primary dentition, anterior open
bite and pacifier sucking habit.
Int J Orofacial Myology. 2006 Nov;32:7-21.

Pacifier use versus no pacifier use in breastfeeding term infants for increasing duration of
breastfeeding.
Cochrane Database Syst Rev.2011 Mar 16;(3):CD007202.

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Educacin Mdica Continua SAVAL Dr. Francisco Moraga
Formacin de competencias en pediatra
SOCHIPE 2015

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Educacin Mdica Continua SAVAL Dr. Francisco Moraga
Formacin de competencias en pediatra
SOCHIPE 2015

MITO # 5
La erupcin dentaria causa fiebre, diarrea y/o dolor.

Does a teething child need serious illness excluding?


Arch Dis Child. 2007 Mar;92(3):266-8.

Is teething in infants associated with fever or other symptoms?


J Fam Pract. 2001 Mar;50(3):257.

Prospective Longitudinal Study of Signs and Symptoms Associated With Primary Tooth Eruption.
Pediatrics2011 Sept; 128(3): 471-6.

Symptoms associated with infant teething: a prospective study.
Pediatrics. 2000 Apr;105(4 Pt 1):747-52.

Editorial: Teething myths.


Br Med J. 1975 Dec 13;4(5997):604.

Cytokine levels in gingival crevicular fluid of erupting primary teeth correlated with systemic
disturbances accompanying teething.
Pediatr Dent. 2003 Sep-Oct;25(5):441-8.

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Educacin Mdica Continua SAVAL Dr. Francisco Moraga
Formacin de competencias en pediatra
SOCHIPE 2015

MITO # 6
Un nio no debe vacunarse si presenta un resfro,
tos o tiene fiebre.

Incidence of adverse reactions to vaccines in a paediatric population.


Clin Drug Investig. 2004;24(8):457-63.

Injection-site reactions to booster doses of acellular pertussis vaccine: rate, severity, and anticipated
impact.
Pediatrics. 2003 Dec;112(6 Pt 1):e453.

Association between health care providers' influence on parents who have concerns about vaccine
safety and vaccination coverage.
Pediatrics. 2006 Nov;118(5):e1287-92.

Evidence Based Route of Administration of Vaccines.


Hum Vaccin. 2007 Jul 15;3(6)

MITO # 7
Si el nio tiene diarrea, diluya la leche a la mitad y
evite verduras verdes y grasas.

The effect of early nutritional supplementation with a mixture of probiotic, prebiotic, fiber and
micronutrients in infants with acute diarrhea in Indonesia.
Asia Pac J Clin Nutr. 2007;16(3):435-42.

Review article: lactose intolerance in clinical practice - myths and realities.


Aliment Pharmacol Ther. 2007 Oct 23;

Early versus Delayed Refeeding for Children with Acute Diarrhoea.


Cochrane Database Syst Rev. 2011 Jul 6;(7):CD007296.

WITHDRAWN: Rice-based oral rehydration solution for treating diarrhoea.


Cochrane Database Syst Rev. 2007 Jul 18;(4):CD001264.

Oral rehydration solution containing a mixture of non-digestible carbohydrates in the treatment of


acute diarrhea: a multicenter randomized placebo controlled study on behalf of the ESPGHAN
working group on intestinal infections.
J Pediatr Gastroenterol Nutr. 2004 Sep;39(3):239-45.

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Educacin Mdica Continua SAVAL Dr. Francisco Moraga
Formacin de competencias en pediatra
SOCHIPE 2015

MITO # 8
Las vitaminas mejoran el apetito y ayudan al nio
que es malo para comer.

Effects of multivitamin-multimineral supplementation on appetite of stunted young Beninese


children.
Appetite. 2002 Oct;39(2):111-7.

Vitamins and trace elements: Practical aspects of supplementation.


Nutrition. 2006 Sep;22(9):952-5.

Vitamins for babies and young children.


Arch Dis Child. 2007 Feb;92(2):160-4.

Multivitamin-multimineral supplements: who uses them?


Am J Clin Nutr. 2007 Jan;85(1):277S-279S.

Social marketing improved the use of multivitamin and mineral supplements among resource-poor
women in Bolivia.
J Nutr Educ Behav. 2004 Nov-Dec;36(6):290-7.

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Educacin Mdica Continua SAVAL Dr. Francisco Moraga
Formacin de competencias en pediatra
SOCHIPE 2015

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S Algunos ejemplos:

El nio que no quiere comer

MITO # 9
Los andadores ayudan al nio a aprender a
caminar.

Success in the prevention of infant walker-related injuries: an analysis of national data, 1990-2001.
Pediatrics. 2006 Mar;117(3):e452-9.

Injuries associated with infant walkers.


Pediatrics. 2001 Sep;108(3):790-2.

Hazards of baby walkers in a European context.


Inj Prev. 1996 Jun;2(2):118-20.

Injury caused by baby walkers: the predicted outcomes of mandatory regulations.


Med J Aust. 2002 Aug 5;177(3):147-8.

Injuries associated with infant walkers. American Academy of Pediatrics Committee on Injury and Poison Prevention.
Pediatrics. 1995 May;95(5):778-80.

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Educacin Mdica Continua SAVAL Dr. Francisco Moraga
Formacin de competencias en pediatra
SOCHIPE 2015

MITO # 10
No hay que dejar que llore para que no se
traume.me mi hijo(a) maneja .

Learned helplessness: Effects of response requirement and interval between treatment and testing.
Behav Processes. 2007 Nov;76(3):183-91.

Early predictors of helpless thoughts and behaviors in children: developmental precursors to depressive
cognitions.
Clin Child Psychol Psychiatry. 2007 Apr;12(2):295-312.

Early life stress alters adult serotonin 2C receptor pre-mRNA editing and expression of the alpha subunit
of the heterotrimeric G-protein G q.
J Neurosci. 2007 Feb 7;27(6):1467-73.

Intimate partner violence and child maltreatment: understanding intra- and intergenerational
connections.
Child Abuse Negl. 2006 Jun;30(6):599-617.

A prospective test of the hopelessness theory of depression in children.


J Clin Child Adolesc Psychol. 2006 Jun;35(2):264-74.

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Educacin Mdica Continua SAVAL Dr. Francisco Moraga
Formacin de competencias en pediatra
SOCHIPE 2015

Criando positivamente

Child Dev 1999; 70(5):1058-66.

Los bebsde madres deprimidaspresentan actividad frontal


elctrica atpica del cerebro durantesus interaccionescon la
madrey conun adulto conocido,no deprimidos.

Biol Psychol 2004; 67(1-2):103-24.


Laregin frontal izquierdahasido identificada como
capaz demediar enlas conductas socialesde
aproximacin yde expresinafectivapositiva.

Int J Neurosci. 2008 Aug;118(8):1081-108.


La promocin yapoyo dela lactancia
materna,lograatenuar ladesregulacin afectivay
fisiolgica en cuanto a la asimetra elctrica frontal
sealadaen los bebsde madres deprimidas.

Criando positivamente

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Educacin Mdica Continua SAVAL Dr. Francisco Moraga
Formacin de competencias en pediatra
SOCHIPE 2015

Criando positivamente
The Functional Neuroanatomy of Pleasure and Happiness
Discov Med 2010; 9(49): 57987.

Las experiencias repetidas de felicidad o infelicidad en la infancia


que contribuir al potencial de felicidad de los nios, y que les ayudar a evaluar en forma positiva y agradecida
lo que les ha sido dado o,
por el contrario, a asumir una actitud pesimista y quejumbrosa.

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Educacin Mdica Continua SAVAL Dr. Francisco Moraga
Formacin de competencias en pediatra
SOCHIPE 2015

Criando positivamente

1. En vez de dar rdenes, haz preguntas que inviten a la reflexin.


2. Habla menos y acta ms. Acrcate a tu hijo y mustrale.
3. Practica la escucha activa: interpretar.
4. Crea rutinas y luego recurdale qu es lo que haban acordado.
5. Dale opciones limitadas. Infrmate.
6. Decide lo que hars y s consecuente.
7. Practica el autocontrol.
8. Ponerse de acuerdo: evitar crear desconfianza.
9. Involucra a tus hijos en la solucin de problemas.
10. Evita anteponer tu sentimiento sobre el del hijo.

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Educacin Mdica Continua SAVAL Dr. Francisco Moraga
Formacin de competencias en pediatra
SOCHIPE 2015

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