Functional constipation related to cow's milk allergy in children: A management proposal.

Functional constipation (FC) is one of the most common disorders in childhood and has a neg-ative impact on the quality of life of children. Scientific evidence regarding a causal relation-ship between FC and cow's milk allergy is controversial, as it is also reported by the latest European Society for Paediatric Gastroenterology, Hepatology and Nutrition-North American Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN–NASPGHAN) rec-ommendations. In the case of FC, routine allergometric tests are not recommended and the cows' milk-free diet is only proposed in the case of laxative-resistant constipation and only following the advice of an expert. Instead, after a careful review of the literature and in view of the many clinical cases encountered in our clinical practice, we believe that it is useful to propose cows' milk-free diet as first line for the treatment of FC at least in pre-school children and in children with a personal or family history of atopy or with a previous diagnosis of cow's milk protein allergy

Desmopressin 120 mcg, 180 mcg, 240 mcg: The right treatment for the right patient

Background: The first-line drug therapy for patients with nocturnal enuresis (NE) associated with nocturnal polyuria and normal bladder function is desmopressin (dDAVP). Objective: To evaluate if increasing dose of oral desmopressin lyophilisate (MELT) can improve response rates to dDAVP and is useful in enuretic children. Materials and methods: We enrolled a total of 260 children all diagnosed with NE. Enuretic children were treated with increasing MELT at a dose of 120, 180 and 240 mcg a day.Results. We included in our study a total of 237 children, 164 males (69.2%) and 73 females (30.8%) aged between 5 and 18 years (mean age 10.32 ± 2.52 years). Of the 237 patients enrolled in the study and treated with MELT 120 mcg, a full response was achieved in 135 (56.9%). A partial response was achieved in 21 (8.9%) patients, therefore the dose was increased up to 180 mcg, with further improving symptoms (14.3%) or full response (9.5%), and up to 240 mcg, without usefulness. Conclusions: MELT at the dose of 120 mcg resulted efficacy and safety; the increased dose up to 180 mcg resulted poorly efficacy; finally, the further increase up to 240 mcg did not improve the symptoms with the increased risk of side effects

Food Protein-Induced Enterocolitis Syndrome: Proposals for New Definitions

Acute food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated allergy and is characterized by repetitive profuse vomiting episodes, often in association with pallor, lethargy, and diarrhea, presenting within 1−4 h from the ingestion of a triggering food. In 2017, the international consensus guidelines for the diagnosis and management of FPIES were published. They cover all aspects of this syndrome, which in recent decades has attracted the attention of pediatric allergists. In particular, the consensus proposed innovative diagnostic criteria. However, the diagnosis of acute FPIES is still currently discussed because the interest in this disease is relatively recent and, above all, there are no validated panels of diagnostic criteria. We propose some ideas for reflection on the diagnostic and suspicion criteria of acute FPIES with exemplary stories of children certainly or probably suffering from acute FPIES. For example, we believe that new definitions should be produced for mild forms of FPIES, multiple forms, and those with IgE-mediated symptoms. Moreover, we propose two clinical criteria to suspect acute FPIES and to refer the child to the diagnostic oral food challenge

Biomarkers Predictive of Metabolic Syndrome and Cardiovascular Disease in Childhood Cancer Survivors

The improvement in childhood cancer treatments resulted in a marked improvement in the survival of pediatric cancer patients. However, as survival increased, it was also possible to observe the long-term side effects of cancer therapies. Among these, metabolic syndrome is one of the most frequent long-term side effects, and causes high mortality and morbidity. Consequently, it is necessary to identify strategies that allow for early diagnosis. In this review, the pathogenetic mechanisms of metabolic syndrome and the potential new biomarkers that can facilitate its diagnosis in survivors of pediatric tumors are analyzed

The adverse effects of oral desmopressin lyophilisate (MELT): personal experience on enuretic children

Objective: The aim of this study was to evaluate adverse effects of oral desmopressin lyophilisate (MELT) in enuretic children. Material and methods: We enrolled 260 children with nocturnal enuresis (NE) referred to the Pediatric Service, \u2018Campus Bio-Medico\u2019 University of Rome, from April 2014 to April 2017 in the study, of these 23 were excluded. The study was characterized by 2 phases. During Phase 1 a careful patient\u2019s medical history was obtained and physical examination was performed. After 3 months of treatment with MELT (Minirin/ DDAVP\uae) at the dose of 120 mcg a day, a micturition diary was kept, adherence to therapy and any possible adverse effects were checked during the Phase 2. The study was carried out in compliance with the Helsinki Declaration. Results: Among 237 patients included in the study 11 male and 6 female (n=17; 7.2%) patients with a mean age 10.06\ub12.49 years, reported 22 adverse effects, with an absolute risk of 7.17%. In particular, 5 neurological symptoms, 3 gastrointestinal effects, 4 sleep disturbances, 8 psycho-behavioral disorders, 2 symptoms of fatigue were reported. Conclusion: In our study MELT with its higher bioavailability guaranteed lower frequency of adverse effects which resolved spontaneously and rapidly. The MELT formulation actually represents the first line and safe treatment for the NE

A Possible Pathogenic Linkage Among Headache, Migraine, and Nocturnal Enuresis in Children

Purpose This study aims to evaluate the prevalence of headaches and migraine in children with nocturnal enuresis (NE) and to improve knowledge on these conditions. In particular, for this purpose, a possible pathogenic relationship linking both conditions and the impact of headaches and migraine on NE persistence was evaluated. Methods Researchers enrolled 123 children with NE, aged between 5 and 15 years, referred to the Service of Pediatrics, Campus Bio-Medico University Hospital of Rome between January 2014 and January 2015. Parents of all children enrolled in the study were invited to complete a self-reported questionnaire. The study protocol was approved by the Human Research Ethics Committee of Campus-Bio-Medico University. The NE group data was compared with the data of a control group (107 children). Results Of the eligible patients, 7.8% suffer from headaches/migraine (mean age, 9.63 years; interquartile range [IQR], 3.5 years) and 47.1% have a family history of headaches (mean age, 8.46 years; IQR, 3.75 years). Of the 8 patients with headaches, all are male, 3 have tension-type headaches (2 of them have maternal family history) and 5 have migraine (3 of them have maternal family history). Of the 35.3% with a migraine family history (mean age, 8.36 years; IQR, 3.5 years), 22 are male, and 14 are female. Three of these patients have migraine. A total of 92.2% suffer from NE but not from headaches (mean age, 8.43 years; IQR, 3 years). Of these patients, 33 are female (35.1%), and 61 are male (64.9%). In the control group, 4.7% (5 out of 107) of the children suffer from headaches, and of these, 4 are affected by nonmigraine headaches and 1 by migraine. Conclusions In conclusion, according to the hypothesis, NE and headaches/migraine could be linked by several similarities

The \u201cbroken\u201d child: Current aspects of the child maltreatment that the paediatricians should know

Child abuse and neglect is a common problem whose outcomes can be very harmful and damaging to the victims. Since it is not easy to recognize the conditions of child abuse and its prevalence certainly is underestimated and the identification of the real number of maltreated children is a challenge. Moreover, as society and culture we live in are constantly and progressively changing, new configurations of child abuse and neglect are emerging. Because of the great impact these situations can have on physical and psychological health of children, every paediatrician should be trained to recognize them and to play a role in supporting the well-being of each child

Enuresis in childhood and bladder cancer in adulthood: Is there "a bridge" that joins?

Introduction The rising incidence of urinary bladder cancer is alarming and potential relationship with micturition disorders have been postulated and incontinence is one of bladder cancer symptoms. We investigate whether exists a possible correlation between bladder cancer occurring in adulthood and a positive history of nocturnal enuresis (NE) in childhood. Materials and methods We retrospectively reviewed a cohort of 100 patients affected by bladder cancer of different grading and staging. All patients were interviewed about voiding disorders during their childhood. Results Four patients suffered from NE during childhood. Of those, 3/4 were affected by urothelial cell cancer (all graded low grade) and 1/4 was affected by keratinizing squamocellular carcinoma (graded G3) Conclusion Our study suggests that there is not a sure correlation between micturition disorders such as NE in childhood and the bladder cancer\u2019s pathogenesis in adulthood

A qualitative survey on distressful voice of children living in foster care

BACKGROUND: The aim of this study was to evaluate the physical and mental condition of children living in a foster care, highlighting the standpoint of social educators working in these settings. METHODS: The data were collected between September and October 2016. The residential child care involved in this study hosted 100 children. All the interviews were registered and transcribed. To analyze the data we used Grounded Theory (GT) methodology. RESULTS: The interviewed underline some aggressive (anger, threats, bullying) and passive (depression, social isolation) children behavior. Aggressive behaviors are more frequent than passive behaviors and the most common children reaction is anger. The most common problem has a psychological aspect, such as excessive responsibility due to the crucial nature of the decisions these professionals have to take and the probability of making mistakes with serious consequences. CONCLUSIONS: Children living in residential child care, like foster care, have still serious deficiencies in their overall health and wellbeing, particularly in emotional health and behavior