Nov. 18, 2015
Volume VI, Issue No. 46

Overweight babies - breast fed vs. formula fed
A study was undertaken of 3,367 infants relating weight gain and obesity in infants to either exclusive breast feeding/formula feeding, or both at age 6 months, with the risk of being overweight at 5-6 years of age.

Overweight infants at 6 months of age have a fourfold greater likelihood of being overweight at 5-6 years of age independent of feeding type.
(L. helveticus-Lh and L. rhamnosus-Lrh combination) in childhood diarrhea
A double-blind, placebo-controlled randomized small study of a combination of probiotics (L.h and L. rh) given in low and high dose for five days to 62 infants/young children (aged 4 months - 48 months) who presented to an Emergency Department with diarrhea and which investigated probiotic use vs. daycare absenteeism (as the outcome) indicates no significant benefit found for probiotics at either dose.

Mothers' emotions and toddlers risk for behavioral problems
It appears from a study of 84 toddlers and mothers from low-income families with a high risk of behavioral problems in their infants, that focusing on educating mothers to understand their own emotional responses, how those affect their toddlers behavior and encouraging them to express positive emotions to their infants is a simple and cost-effective method to enhance toddlers' social-emotional development and decrease the later development of behavioral problems.
In the Nov 11th issue of Updates in Pediatrics, the statement "12% of alert children with GCS's of 15 have raised ICP", should read " 12% of alert children with GCS's of 15 have ICI (intracranial injury)".  -Ed.



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TV exposure and children

The American Academy of Pediatrics recommends that parents should avoid TV screen time for babies/infants <2 years of age (early screen time is associated with decreased language and cognitive development, school achievement, executive function and a wide range of negative behaviors), and limit total screen time to <2 hours per day for children >2 years of age (negatives include increased risk of obesity and aggression).

Babies learn through real-life interactions and even though new technologies enable infants to react, respond, to have programs customized, be progressive and to be portable (as well as being exposed to advertising and violence that they are too immature to deal with) parents tend to pay less attention to their infants which may result in less one-on-one experiences with their infants and over time unknown consequences (no doubt the benefits and risks of the new technology will be more clearly delineated later, Ed).
Video Feature
Probiotics in childhood diarrhea
Probiotics in childhood diarrhea
Fecal calprotectin (f-CP); Can it be used to distinguish between bacterial and viral gastroenteritis in children?

Calprotectin is a complex of human proteins that in the presence of calcium sequesters nutrient manganese and zinc; these actions account for its antimicrobial properties. It is secreted during inflammation and fecal Calprotectin has been used to detect intestinal inflammation.

A study of 84 children (<18 years of age) with gastroenteritis had stool microscopic examination and cultures for bacteria and parasites. PCR was utilized on stool samples to identify viruses and the level of f-CP measured and quantified against organism found.

"f-CP is a useful, valuable, non-invasive and rapidly measured laboratory test complementing simple microscopic examination of the stool". High levels (threshold 710mg/l) are found with bacterial intestinal inflammation.
Predictors of patient adherence to follow-up recommendations after an Emergency department (ED) visit

A prospective observational study of 428 patients from a single urban ED indicates that at follow-up 89.7% of patients comply with ED recommendations made, particularly those with a primary care provider, an income >$35,000 /year and who are non-Hispanic; those who report "cost" being a factor are significantly less likely to comply.
American Journal of Emergency Medicine 
Kidney stones in overweight children
Urolithiasis (kidney stones, renal stones and/or renal calculi) refers to the accumulation of hard, solid non-metallic material in the urinary tract.

Nephrocalcinosis is the term used to describe increased calcium content of the parenchyma of the kidney.

Renal stones usually form as a result of either supersaturation of stone-forming compounds in the urine (e.g. dietary, oxalates, etc.), the presence of a chemical or physical stimulus in urine, and/or decreased amounts of substances in the urine (e.g. magnesium, citrates etc.) that inhibit stone formation. Other factors may play a role. There is conflicting evidence about the role of obesity.

A study compared serum lipid profiles and 24 hour urine chemistry of 493 overweight/obese children (mean age 13 years) without kidney stones to 492 healthy sex and age-matched controls.

Increased serum lipid fraction abnormalities correlate with hypocitraturia predisposing overweight children to kidney stones.

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Exposure to acid suppression is associated with what GI disorder?
What is the average age of a patient suffering from childhood osteomyelitis?
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selective eating disorder?

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