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EFEITO DE ORIENTAÇÕES DE COMPORTAMENTOS MATERNOS DE SINCRONIA E DE TERAPIA MANUAL NO NÚMERO DE REGURGITAÇÕES EM LACTENTES SAUDÁVEIS E NA ANSIEDADE MATERNA
Dissertação apresentada ao Programa de Pós- Graduação em Saúde da Criança e do Adolescente da Universidade Federal de Pernambuco como requisito parcial para a obtenção do grau de mestre. Área de concentração: Saúde da Criança e do Adolescente RESUMO A ocorrência de regurgitação infantil (RI) pode ser explicada por fatores biológicos, relacionados ao lactente, como a desregulação do sistema digestório; e por fatores biopsicossociais associados à relação família-bebê. O modelo biomédico de tratamento da RI não traz a resolutividade esperada para os bebês e as famílias. A abordagem não medicamentosa através da terapia manual (TM) e seu possível efeito sobre o sistema nervoso autônomo (SNA), assim como estratégias de fortalecimento da relação mãe-bebê, podem ser uma alternativa para conduzir melhor a RI, considerando sua origem biopsicossocial. O objetivo do estudo foi verificar o efeito de orientações de comportamentos maternos de sincronia e de um protocolo de terapia manual sobre o número de regurgitações de lactentes saudáveis e a ansiedade materna. Foi realizado um ensaio clínico, simples cego, randomizado e controlado com dupla intervenção em díades de mães e lactentes saudáveis que apresentavam duas ou mais regurgitações em 24 horas. As díades foram randomizadas em grupo intervenção (GI) e grupo controle (GC). Ambos os grupos receberam a intervenção de orientações de comportamentos maternos de sincronia com olhar, vocalização e toque através de massagem realizada pela mãe. Ao GI foi aplicado um protocolo de terapia manual, com técnicas do método Busquet, nas inserções diafragmáticas anteriores, região epigástrica e coluna vertebral. Os desfechos avaliados foram número de regurgitações nas últimas 24 horas, média do número de regurgitações no registro de três dias, percepção materna sobre redução das regurgitações e ansiedade materna através do inventário de ansiedade IDATE – estado. Foram acompanhadas 26 díades, perfazendo 12 no GI e 14 no GC. Em ambos os grupos houve redução no número das regurgitações do 4o mês em relação ao 1o, tanto quando se considera regurgitação nas 24 horas (GI p=0,03 e GC p=0,04), quanto o registro de três dias (GI p=0,09 e GC p=0,05). Estas reduções foram observadas já no 2o mês somente no GI, tanto no número de regurgitações nas últimas 24 horas (p=0,03) quanto no registro de três dias (p=0,07) e na ansiedade materna (p=0,02), o que não foi observado no GC. Não houve uso de medicação para refluxo gastresofágico em nenhum grupo durante os quatro meses e os bebês do GI foram massageados por mais dias no 2o mês de vida que o grupo controle (p=0,06). O estudo conclui que díades de mães e bebês saudáveis que receberam orientações de comportamento materno de sincronia com vocalização, olhar e toque através de massagem apresentaram redução no número de regurgitações e na ansiedade materna no quarto mês pós-parto e que esta redução parece ser antecipada para o segundo mês quando a intervenção é associada a um protocolo de terapia manual sob as regiões diafragmática, epigástrica e coluna vertebral. Palavras-chave: Refluxo gastroesofágico. Terapia manual. Interação mãe-filho. Comportamento materno. Lactentes.