Health-related quality of life in children and adolescents with autoimmune hepatitis

Objetivo: Avaliar a qualidade de vida relacionada à saúde (QVRS) de crianças e adolescentes com hepatite autoimune (HAI). Métodos: Estudo transversal avaliou 80 pacientes com HAI e 45 controles saudáveis utilizando o instrumento Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0). Os dados demográficos, a presença de comorbidade autoimune, dose de corticóide, remissão e gravidade da doença e dor abdominal também foram avaliados. Resultados: A idade atual média foi similar em pacientes HAI e controles saudáveis [13 (5-18) vs. 14 (3-18) anos, p = 0,804]. De acordo com os relatos das crianças, os escores físico, emocional e escolar foram significativamente menores nos pacientes com HAI comparado ao grupo controle (p 0,05). Pacientes em uso de doses = 0.16 mg / kg / dia no momento da entrevista, mostraram prejuízo significante no domínio físico [87,5 (50-100) vs. 75 (15,63-100) vs. 87 (50-100), p = 0,006]. Conclusões: Observouse redução de capacidades física, emocional e escolar em pacientes pediátricos com hepatite autoimune. Dor abdominal e dose de prednisona em uso influenciaram negativamente na QVRS de crianças e adolescentes com HAIObjective: To evaluate health related quality of life (HRQL) in children and adolescents with autoimmune hepatitis (AIH). Methods: A cross-sectional study assessed 80 patients with AIH and 45 healthy controls using Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) instrument. Demographic data, presence of autoimmune comorbidity, prednisone dose, disease remission, disease severity and abdominal pain were also evaluated. Results: According to the child-self report, physical, emotional, school and total scores were significantly lower in AIH patients compared to controls (p 0.05). AIH patients using prednisone dose below the median ( < 0.16 mg/kg/day) had significantly reduced physical score [87.5(50-100) vs. 75(15.63-100) vs. 87 (50- 100), p=0.006]. Conclusions: Reduced scores in physical capacity, emotional and school domains were observed in pediatric AIH patients. Abdominal pain and corticosteroid dose influenced negatively the HRQL in children and adolescents with AI

Delayed Development of Feeding Skills in Children with Feeding Difficulties—Cross-sectional Study in a Brazilian Reference Center

BackgroundDelays in gross motor development, sensory processing issues, and organic and behavioral problems are known to interfere in the development of feeding skills (FS); and—therefore—in the success of the process of feeding a child. Children with feeding difficulties (FD) commonly present inadequacy of FS.ObjectivesAssessment of five FS in Brazilian children with FD, and search of associations with types of FD.MethodsCross-sectional study with 70 children below 10 years old. Data were obtained from medical records: age, gender, age at texture transitions, feeding phase (breastfeeding, weaning to solids or full solids) at first complaint; characteristics of the meal (duration, environment, and shared meals with adults), self-feeding practices, use of feeding equipment and bottle, mouthing, feeding position and FD diagnosis. Skills were categorized according to standards for age. Chi-Square, Anova Test (or non-parametric equivalent) and Multinomial logistic regression tests were used, with a significance level of 5%.ResultsThere was no difference in FS (p &gt; 0.05) or in the number of FS inadequateness (p = 0.84) according to FD diagnosis. The majority (94%) of children presented at least one delayed development of FS; 1/3 presented delays in more than half of the FS. The most prevalent inadequacies in FS were inadequate feeding position (73.5%), prolonged bottle feeding (56.9%), and inadequate self-feeding practices (37.9%). Feeding complaints first appeared at 10.9 ± 11.4 months, and picky eating was the most prevalent type of FD (37.1%). Most children were fed in inadequate environments (55.2%), without the company of adults (78%). Transition to solid foods occurred at 16 ± 5.6 months. Multinomial logistic regression showed no difference in likelihood of presenting any type of FD compared to picky eating, according to FS. Age at texture transition both from breastfeeding to complementary feeding (p = 0.95), and from complementary feeding to solid foods (p = 0.43) did not vary according to FD diagnosis.ConclusionFS development or number of FS inadequateness did not vary according to FD diagnosis. Identification of these inadequacies could help the discussion for multi-professional treatment of patients with FD

O PEDIATRA DEVE INVESTIGAR SINTOMAS DE TRANSTORNOS OBSESSIVOS COMPULSIVOS EM CRIANÇAS COM DIFICULDADES ALIMENTARES?

RESUMO Objetivo: Revisar evidências atuais da relação entre transtorno obsessivo compulsivo e dificuldades alimentares. Métodos: Revisão das bases Science Direct e PubMed no período entre 2007 e 2017 em inglês, português e espanhol, com os termos em associação “transtorno obsessivo compulsivo” e “picky eating/dificuldade alimentar”. Foram selecionados apenas estudos de coorte, caso controle ou transversal, realizados em qualquer país, com crianças, adolescentes e/ou adultos e de qualquer tamanho amostral. Foram excluídos os artigos de opinião. Resultados: Cerca de 245 artigos foram selecionados e apenas 4 foram incluídos no estudo, segundo critérios de seleção. Os trabalhos descrevem essencialmente que há diferença no comportamento seletivo entre os sujeitos com e sem transtorno obsessivo compulsivo, com tendência para exacerbação de sintomas como nojo, ansiedade e escore de inflexibilidade de comportamento alimentar nos pacientes com esse transtorno. Conclusões: Existem sintomas compartilhados entre transtorno obsessivo compulsivo e dificuldade alimentar. O estudo alerta aos profissionais que acompanham pacientes com dificuldades alimentares para a importância da investigação de possíveis comorbidades psiquiátricas

Maternal Feeding Practices among Children with Feeding Difficulties—Cross-sectional Study in a Brazilian Reference Center

BackgroundGiven the positive influence of responsive caregiving on dietary habits in childhood, to raise awareness of caregivers regarding their behavior is crucial in multidisciplinary care on infant feeding.ObjectivesTo identify the most common responsive and non-responsive feeding practices in mothers of children with feeding complaints, as well as to seek associations between practices and caregivers’ profile.MethodsCross-sectional study with 77 children under 18 years old, with complaints of feeding difficulties. Data were collected during interviews with mothers: child age, gender, duration of exclusive breastfeeding, presence of organic disease, dynamics of bottle use, self-feeding practices and posture at meals, use of appropriate feeding equipment; basic information about the mothers (parity and level of education), caregiver feeding style, presence of coercive feeding, frequency and characteristics of family meals. Statistical analysis considered significance level at 5%.ResultsThe non-responsive profile predominated among mothers (76.2%, with the Authoritarian style being the most prevalent—39.7%). The responsive profile was characterized by absence of coercive feeding, stimulation of self-feeding practices, use of appropriate feeding equipment and meal environment, with interaction at meals. Non-responsive profile consisted of both inadequate environment and posture at meals, use of distraction and coercive feeding, lack of shared meals, and disregard for children’s hunger signals. Only the habit of sharing meals with children was associated with mothers’ profile, and considered a protection factor against non-responsive care (OR 0.23; 95% CI 0.06–0.88). Both Authoritarian (p = 0.000) and indulgent mothers (p = 0.007) breastfed exclusively for longer time than negligent ones. There was a higher level of interaction with children in “responsive” parental style (OR 0.056; p = 0.01) compared to other feeding styles.ConclusionResults highlight the need for educational interventions focused on caregivers’ behaviors

Does family mealtime have a protective effect on obesity and good eating habits in young people? A 2000-2016 review

Abstract Objectives: to review the prevalence of family meals and its impact on BMI and eating habits during childhood and adolescence. Methods: reviews are from Bireme / Lilacs / Scielo / Cochrane and Pubmed, between 2000-2016 with descriptors "family meal or mealtime", "behavior", "nutrition or diet or consumption or eating", and "child or children or adolescence"; performed by two independent examiners, according to the systematic steps in English and Portuguese. The articles were selected based on prevalence and/ or discussion between nutritional variables. 2,319 articles were found, which 15 were selected all in English: systematic reviews (n=2), cross-sectional studies (n=8), longitudinal studies (n=8); all related to children (n=5), adolescents (n=6) and both (n=5). Results: the mean of shared meals was 1x/day, with a prevalence of 27 to 81%. Most studies (n=13) reported the beneficial impact on BMI, higher consumption of fruit and vegetables, protein, calcium and a lower consumption of sweets and sugar sweetened beverages, family union and self-regulation of appetite. Conclusions: having daily family mealtime has beneficial effect on the nutritional status and children and adolescents' eating behavior