title: Association between exclusive maternal breastfeeding during the first 4 months of life and primary enuresis.
abstract: BACKGROUND
  Although the relationship between enuresis and breastfeeding is still poorly documented in the literature, a possible association is speculated as both are strongly associated with children's development. Therefore, the main objective of this study was to evaluate whether there is an association between primary enuresis and the duration of exclusive breastfeeding.
  
  
  METHODS
  This is an observational, case-control study, involving 200 children and adolescents from 6 to 14 years old, who were divided into two groups: the enuresis group (EG), composed of 100 children with primary enuresis; and the control group (CG) of 100 matched children without enuresis. The matching criteria were sex, age, and socioeconomic level. Adults responsible for each infant answered a structured questionnaire to identify biological and behavioral factor, as well as the duration of maternal breastfeeding. Children whose parents could not comprehend the questionnaire or children with neurological or psychiatric disorders or secondary enuresis were not included in the study.
  
  
  CONCLUSIONS
  Evaluating the duration of exclusive breastfeeding, 72% of the subjects of the EG and 42% of the CG had been breastfed for less than 4 months (p < 0.001) (Figure). In bivariate analysis, there was a strong association between symptoms of enuresis with a positive family history of enuresis and duration of exclusive breastfeeding (p < 0.001), and also association with full breastfeeding duration (p = 0.044), number of children (p = 0.045), and parents' education (p = 0.045). After logistic regression, primary enuresis continued to be associated with duration of exclusive breastfeeding and family history of enuresis. The proportion of children that had been exclusively breastfed for more than 4 months was significantly higher in the CG 58% (58/100) than in the EG 28% (28/100) (p < 0.001, OR 4.35, 95% CI 1.99-9.50).
  
  
  CONCLUSIONS
  This study confirmed the association between primary enuresis and various factors that have already been studied, with the addition of a new factor, duration of exclusive breastfeeding for less than 4 months, which is strongly associated with primary enuresis.
authors.affiliation: Department of Surgery, Division of Urology, Federal University of Juiz de For a, UFJF, Brazil. Electronic address: dayanafisio20@outlook.com.
authors.forename: Dayana Maria
authors.initials: DM
authors.lastname: de Oliveira
authors.affiliation: Department of Surgery, Division of Urology, Federal University of Juiz de For a, UFJF, Brazil.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Dahan
authors.affiliation: Department of Surgery, Division of Urology, Federal University of Juiz de For a, UFJF, Brazil.
authors.forename: Dnyson Fernandes
authors.initials: DF
authors.lastname: Ferreira
authors.affiliation: Department of Surgery, Division of Urology, Federal University of Juiz de For a, UFJF, Brazil.
authors.forename: Liliana Fajardo
authors.initials: LF
authors.lastname: de Oliveira
authors.affiliation: Department of Surgery, Division of Urology, Federal University of Juiz de For a, UFJF, Brazil.
authors.forename: Lidyanne I da Silva
authors.initials: LI
authors.lastname: de Paula
authors.affiliation: Department of Surgery, Division of Urology, Federal University of Juiz de For a, UFJF, Brazil.
authors.forename: André Avarese
authors.initials: AA
authors.lastname: de Figueiredo
authors.affiliation: Department of Surgery, Division of Urology, State University of Feira de Santana, UEFS, Brazil.
authors.forename: José
authors.initials: J
authors.lastname: de Bessa
authors.affiliation: Department of Surgery, Division of Urology, Federal University of Juiz de For a, UFJF, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora - SUPREMA, Brazil.
authors.forename: José Murillo
authors.initials: JM
authors.lastname: Bastos Netto
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D001942:Breast Feeding / Q000379:methods*; D002648:Child; D004775:Enuresis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013997:Time Factors
keywords: Breastfeeding; Child; Incontinence; Nocturnal enuresis; Risk factors