Recurrent Abdominal Pain in Children

Recurrent abdominal pain is one of the most common symptoms found in children. Description of abdominal pain is important in determining the etiologic cause. Organic pain must be ruled out first before suspecting psychogenic cause of pain. However, Children and infant are likely having difficulties in describing abdominal pain. Referred pain may lead to misdiagnosis. Alarm symptoms of abdominal pain are important indices and must be recognized. Careful and complete anamnesis and physical examination play critical role in management approach of recurrent abdominal pain in children and determine whether medical therapy only or combination with surgical intervention is considered necessary

Breastfeeding practices in mothers: a qualitative study

Background Despite the WHO and UNICEF recorrunendations, the well-known breastfeeding benefits, and the efforts to promote and support breastfeeding; exclusive breastfeeding by Indonesian mothers remains low and contributes to high infant mortality rates. Objective To elucidate the fac tors that influence mothers' choices for infant feeding Methods This qualitative study was conducted as part of a nationwide survey. The study included 36 in-depth interviews of mothers with infants aged 0-11 months, and health care professionals, including general practitioners, pediatricians, and midwives. This study was performed between 0 cto ber - November 2 0 l 0 in both rural and urban areas of 4 provinces in Indon esia. Results We found that most mothers intended to breastfeed and had positive perceptions of breastfeeding. However, mothers faced many challenges in the practice of exclusive and proper breastfeeding. Additionally, the perceived definition of exclusive breastfeeding varied among the participants, leading  to n on-exclusive breastfeeding attitudes. The most frequent reasons for mothers to introduce additional milk formula or food were the perception of an inadequate milk supply, infant dissatisfaction or fu ssiness after feeding. Different perceptions were also demonstrated in different regions and the varying levels of socioeconomic status. Health care practitioners (HCPs) were the most reliable source for giving adequate information, but unfortunately, they were not easily accessible and provided inconsistent information. Consequently, closely-related family members were the major contributors of information to a mother's choice of infant feeding; because they were easily accessible. Conclusion Factors influencing mothers in their breastfeeding practices are their basic knowledge, demographic and socioeconomic status, as well as the availability of support from closelyrelated family members, friends, and HCPs

The Role of Supporting Examinations on the Diagnosis of Chronic Diarrhea in Children

Background: Etiology of chronic diarrhea can be established through non-invasive examination such as stool examination and stool culture. Colonoscopy is an invasive Method, which is occasionally needed to discover the etiology of chronic diarrhea. Objective: To recognize the characteristics of chronic diarrhea based on stool examination and colonoscopy results. Methods: Descriptive study on patients with chronic diarrhea who came to Cipto Mangunkusumo hospital since 1 June to 31 August 2005. Laboratory tests were conducted in accordance with clinical indication. Data was presented in distribution tables. Results: There were 41 patients with chronic diarrhea. Stool examination were performed only in 38 patients with negative-gram infection (86.8%). Stool cultures were performed in 27 patients with positive results of non-pathogenic Escherichia coli (85.2%). Stool parasite examination and concentration tests were performed in 17 patients, with 47.0% positive results as follow: Microsporidia 29.4%, Blastocystis hominis 11.8% and Giardia lamblia 5.9%. Colonoscopy examinations were performed in 6 patients and all patients indicated ulcerative colitis appearance with 50% histopathological impression of infective colitis. Conclusion: Stool examination in chronic diarrhea primarily indicates positive infection. Bacterial stool culture mostly includes non-pathogenic Escherichia coli, while parasite stool examination largely includes Microsporidia. Biopsy examination tends to reveal infective colitis

Exclusive breastfeeding rate and factors associated with infant feeding practices in Indonesia

Background Breast milk is the ideal food for infants. According to the 2007 Indonesian National Household Health Survey, only 23% of mothers exclusively breastfeed for six months. Objectives To determine the rate of exclusive breastfeeding in Indonesia, to evaluate factors associated with infant feeding practices, and to compare the nutritional and developmental status between exclusively-breastfed and formula-fed infants. Methods A survey was conducted in hospitals located in 17 provinces in Indonesia. The rate of exclusive breastfeeding was calculated. Many variables were investigated as potential predictors for exclusive breastfeeding using a multivariable logistic regression analysis. Further analysis was performed to compare the nutritional and developmental status between exclusively breastfed and formula-fed infants at the time of survey. Results From 1,804 infant subjects, the overall rate of exclusive breastfeeding was 46.3%, ranging from 10.5% in East Java to 66.9% in Jambi. Predominant breastfeeding, complementary feeding, and formula feeding rates were 14.3%, 8.6%, and 30.7%, respectively. Maternal unemployment was associated with a longer duration of breastfeeding (P=0.000). There were significantly more formula-fed infants who were undernourished compared to exclusively-breastfed infants (14% vs. 8%, P=0.001). There were also significantly more infants in the formula-fed group who had abnormal head circumference compared to those in the exclusively-breastfed group (9% vs. 6%, P=0.031). Child development, as assessed by the Pre-screening Developmental Questionnaire, was similar between the two groups (P=0.996). Conclusion The overall rate of exclusive breastfeeding in Indonesia is 46.3%. Maternal unemployment is associated with longer duration of breastfeeding. Exclusive breastfed infants have significant better growth and head circumference compared to formula fed infants, while the development is similar between the two groups

Pola Defekasi pada Anak

Defekasi merupakan salah satu aktivitas manusia yang harus dilalui di dalam kehidupan sehari-harinya. Pola defekasi pada anak sangat bervariasi dan sangat bergantung pada fungsi organ, susunan saraf, pola makan, serta usia anak. Menilai pola defekasi pada anak berarti menilai frekuensi defekasi, konsistensi dan warna tinjanya. Berdasarkan penelitian yang telah dilakukan di beberapa negara di Amerika, Eropa, dan Asia-Pasifik diketahui bahwa terjadi penurunan frekuensi defekasi sesuai dengan bertambahnya usia anak, sedangkan perubahan konsistensi dan warna tinja sesuai dengan pola makan. Sejauh ini belum pernah dilaporkan tentang pola defekasi pada anak Indonesia

Lactose malabsorption in junior high school children

Background The prevalence of lactose malabsorption varies widely throughout the world. Only people of Caucasian genetic background continue to produce high amount of lactase throughout adulthood. Previous studies in Indonesia revealed that the prevalence of lactose malabsorption was 21-58% in children aged 3-11 years. Objective To determine the prevalence of lactose malabsorption in the older age group and whether a change in milk drinking habit can affect it. Methods A cross sectional descriptive study was conducted on 98 children aged between 12 and 14 years (junior high school) in Jakarta. Lactose malabsorption was evaluated with Lactometer Breath Hydrogen Test (Hoek Loes, Amsterdam). Milk drinking habit was recorded, and drinking at least 1 glass of milk everyday since 6 months or more before the study was considered as regular milk drinking. Results This study showed 73% of the children had lactose malabsorption. Regular milk drinking habit was found in 32 (33%) children and lactose malabsorption occurred in 26. From 66 children who were irregular milk drinkers, lactose malabsorption was found in 46 (70%). Lactose intolerance was about the same in both groups. Conclusion There was an increasing prevalence of lactose malabsorption in older children. Milk drinking habit is a major concern to review the practical implications of lactose malabsorption

Development of Food Multi-Mix Using a Linear Programming Approach to Fill the Nutrient Gap of Amino Acids and Micronutrients for Stunted Non-Wasted Children

Food-based approaches using locally available food escalates the feasibility and the sustainability of nutrition intervention. A complementary feeding recommendation (CFR) integrated with the food multi-mix (FMM) formulation was targeted to fulfill micronutrient and amino acid requirements for stunted non-wasted (SNW) children aged 12–23 months living in agricultural areas. A seven-day estimated food record (EFR) of 87 children was used to design the CFR and 4 identified underutilized foods were integrated as the FMM. A linear programming approach using Optifood was applied to optimize the CFR and FMM. CFR alone successfully fulfills the vitamin C, riboflavin, iron, and zinc, but it cannot fulfill calcium, thiamin, niacin, vitamin B6, folate, vitamin B12, and histidine. With the incorporation of the selected underutilized cowpea, buncis batik, wader fish, and cows’ milk in the FMM development, the nutrients that are challenging in CFR development, can be fulfilled. Therefore, these findings present evidence that food multi-mix developed based on locally available nutrient-dense food sources can help to meet the nutrient gaps, which often remained even after a complementary feeding diet is optimized. Efficacy study using the developed CFR and FMM is recommended to assess effect in improving intake of micronutrients and amino acids and improving the linear growth of stunted, non-wasted children