1,720,976 research outputs found
Managing gastro-oesophageal reflux in infants
No full textTransient, inappropriate relaxation of the lower oesophageal sphincter may permit contents of the stomach to pass into the oesophagus (so-called gastro-oesophageal reflux [GOR]).1 This usually presents as regurgitation or vomiting and is common in infants, when it is usually mild and self-limiting, and requires no specific treatment.1 Gastro-oesophageal reflux disease (GORD) in infants describes reflux of gastric contents that causes troublesome symptoms or complications.2 GORD is sometimes wrongly diagnosed in healthy infants with troublesome but harmless symptoms of ‘physiological’ GOR.3 This has led to increasing, potentially inappropriate, use of acid reducing drugs.3,4 Furthermore, few of the drugs used to treat infants with GORD are licensed for this indication, a situation that DTB criticised 12 years ago.1 Here we consider GORD in infancy (i.e. in those aged 0–12 months), the treatments available and when these are needed
Outcome of nutritional screening in the acute paediatric setting
No full textIntroduction: multiple nutritional risk assessment tools are available, but there are limited data on their application in the acute setting. We explored the validity of two tools in a tertiary Children's Hospital's acute unit and the cohort's nutritional status using WHO definitions.Methods: prospective study n=300 (median 38 months; 44.6% female; 25.7% ≤12 months). Participants had standard anthropometry measured, all were screened using the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), the Paediatric Malnutrition Screening Tool (PMST) (modified STAMP) and 125 were additionally screened using the Paediatric Yorkhill Malnutrition Screening (PYMS) tool.Results: the percentages with medium/high nutritional risk were as follows: STAMP 73.1%, PMST 79.3% and PYMS 30%. Height/weight were normally distributed with: 3.4% stunted (height-for-age z-score <-2); aged ≤ 5 years, 6.8% wasted (weight-for-height z-score (WHZ) <-2), 17.9% overweight (WHZ 1-2) and 6.2% obese (WHZ >2); aged >5 years, 5.8% thin (body mass index (BMI)-z-score (BAZ) <-2), 17.3% overweight (BAZ 1-2) and 5.8% obese (BAZ >2). The tools showed poor specificity and variable sensitivities when compared with WHO malnutrition criteria, with positive predictive values of <50%. κ-Analysis also showed poor agreement between the tools and the WHO cut-offs.Conclusions: these results suggest that nutritional screening tools have poor sensitivity and are difficult to interpret in the acute setting. It may be more effective to include the assessment of weight and height and nutritional intake in the context of the acute presentation as part of routine clinical assessment rather than relying on screening tools to identify those at risk
Energy expenditure, nutrition and growth
No full textFundamental to appropriate nutritional prescription is an understanding of the conditions necessary for growth that include the requirements for energy in health and illness. Energy requirements need to be met by the dietary intake to prevent weight loss. A positive energy balance will result in weight gain. Energy requirement includes several components; the largest is the basal metabolic rate, although physical activity level and the energy needs of growth are important components. All aspects of energy metabolism are likely to be influenced by illness and impact on energy balance. Changes in dietary intake and physical activity are observed clinically but poorly described in most childhood illnesses. Changes in metabolic rate are poorly described in part owing to methodological problems. This review explores changes in energy expenditure associated with health and disease, highlights the lack of evidence underpinning this aspect of practical nutritional support and provides the clinician with a guide to the factors involved in estimating energy requirements, emphasising the importance of measuring the child's response to nutritional support. <br/
Anaemia and iron deficiency in children with inflammatory bowel disease
No full textBACKGROUND AND AIMS: Anaemia and iron deficiency are common in children with Inflammatory Bowel Disease (IBD) however it is not known if the prevalence of anaemia and iron deficiency alters following diagnosis.METHODS: Laboratory results from diagnosis, and at follow up one and two years later were recorded retrospectively in children with IBD recruited from a tertiary centre. Anaemia was defined using WHO standards and iron deficiency defined using published guidelines.RESULTS: 46 children (16 girls) with Crohn's disease and 34 children (18 girls) with UC were studied. 75% of children with IBD were anaemic at diagnosis, 30% were anaemic at follow up two years later. 90% of children with Crohn's and 95% of children with Ulcerative Colitis (UC) were iron deficient at diagnosis. At follow up two years later 70% of children with Crohn's and 65% of children with UC were iron deficient.CONCLUSIONS: Persistent anaemia and iron deficiency are common in childhood IBD, prevalence alters with duration of time from diagnosis
Patient, parent and professional perception of the use of maintenance enteral nutrition in Paediatric Crohn's Disease
No full textAim:
Maintenance enteral nutrition (MEN) is routinely used in Paediatric Crohn's Disease (CD) to prolong remission although there is limited evidence for efficacy and a lack of formal guidelines. This study surveyed patients’, parents’ and professional experience with MEN.
Methods:
Two questionnaires were developed to survey the experience of MEN; (i) Patients/Parents (children >10 years of age aimed to complete independently) and (ii) Dietitians. Questionnaires were sent to families prescribed MEN after exclusive enteral nutrition (EEN) between 2015‐17 (n = 77) and dietitians working in paediatric regional centres in UK (n = 23).
Results:
Response rate to the questionnaires was 53% patients, 62% parents and 83% dietitians. Patients/parents reported medical/dietetic advice to be the primary factor affecting compliance, 30% patients reported side effects. Fifty‐six per cent of patients/58% parents stated a preference for dietary advice rather than MEN. Dietetic responses indicated 79% used MEN after EEN as standard procedure and 79% did not have exit criteria for MEN. Sixty‐eight per cent perceived the taste was the primary factor affecting patient compliance.
Conclusion:
Patients’ perception of the usefulness of MEN differs to professionals. This study highlights the extensive practice of MEN after EEN in clinical remission, which may not be nutritionally indicated. Patient preference is for dietary advice rather than MEN
Measured versus predicted energy expenditure in children with inactive Crohn's disease
No full textIntroduction: The aim of the study was to assess if the estimated average requirements for energy for normal children (EAR) and the Schofield equation could reliably predict energy requirements in children with inactive Crohn's disease (CD).Methods: Twenty-three children with inactive CD were studied, median age 14.3 years (range 7.8–16.9). Resting energy expenditure (REE) was measured by indirect calorimetry and compared with that predicted using the Schofield equation (BMR). Total energy expenditure (TEE) was measured using REE and a 3-day activity diary and compared with EAR.Results: REE ranged from 79% to 136% of BMR. Mean REE was not significantly greater than mean BMR (P=0.25 2-tailed t-test). TEE ranged from 72% to 163% of estimated average requirements for energy for children of that weight (EARw). EARw tended to underestimate TEE in large children and overestimate TEE in small children (Bland–Altman plot R=0.5, P=0.002). EARw was a poor predictor of TEE (R=0.35, P=0.1). EAR underestimated energy requirements by >500 kcal/day in 40% of the children.Conclusions: The Schofield equation and EAR are unreliable methods of predicting total energy requirements in children with inactive CD with a significant potential to underestimate energy needs. When energy requirements were greater than EAR it was due to physical activity and body habitus rather than raised REE
Outcome of childhood ulcerative colitis at 2 years
No full textAim: Ulcerative Colitis (UC) has an incidence of 1.4 per 100 000 in childhood. There is a paucity of data regarding outcome particularly with the increased use of early immunosuppression. This study reviews outcome at 2 years in a cohort with UC referred to a single centre.Method: Patients were recruited on the basis of a diagnosis made between 2000 and 2003 as a consecutive cohort. All had UC according to standard clinicopathological criteria. Children with indeterminate colitis were excluded. Follow-up data was collected at 2 years by case notes review.Results: Thirty-two children are reported. The median age at diagnosis was 11 years (range 2–16). All were treated with corticosteroids and 5-ASA derivatives at diagnosis. The majority of patients (94%, 30/32) received more than one course of steroids. By 2 years azathioprine use was high with 75% (24/32) of patients on treatment for steroid-dependent disease. There were 6 extra-intestinal manifestations and 8 disease related complications occurring in 12 patients (38%). The colectomy rate was 9% (3/32) for unresponsive disease.Conclusion: There is a high need for Azathioprine in childhood UC. Colectomy rate at 2 years was around 10%. Extra-intestinal manifestations and disease related complications are common
Erythema ab igne and Crohn's disease
No full textThis 13-year-old boy presented with a 2-month history of abdominal pain, bloody diarrhoea and weight loss (10 kg). On examination, he was wasted and had a non-tender, reticular, macular, pigmented rash on his anterior abdominal wall (fig 1). He attributed the rash to frequent use of a hot water bottle, which had helped to settle his pain. Inflammatory markers were raised,
Nutrition issues in pediatric Crohn's disease
No full textTwenty-five percent of inflammatory bowel disease (IBD) diagnoses present in childhood, with Crohn's disease (CD) being the most common type. Many children have poor nutrition status at presentation of the disease, which may worsen during the clinical course, with a significant number of children having impaired linear growth. The cause of this poor nutrition status is complex, and contributing factors include inadequate intake, malabsorption, altered energy demands, and losses through stool, particularly in colitis. The principal aim of medical management is to induce disease remission, with minimal side effects, thereby enabling normal growth and development. This must include active consideration of the nutrition needs of such children and how they may be best met. However, our understanding of the manner in which the disease process affects the energy demands of children with CD or how poor nutrition, in turn, may affect the disease course is limited. This may constrain the efficacy and effectiveness of standard therapeutic approaches to care. This review explores the many factors of relevance in the delivery of nutrition support to children with inflammatory bowel disease, and explores the role of exclusive enteral nutrition as a corticosteroid-sparing strategy to induce remission in children with active Crohn's diseas
Screening tools for paediatric malnutrition: are we there yet?
No full textPURPOSE OF REVIEW:The development of nutritional screening tools has done much to raise the profile of nutrition and encourage healthcare practitioners to consider how to identify children at nutritional risk. However, the next challenge is to ensure nutritional screening accurately identifies those who have immediate and ongoing risk and therefore the potential to impact on it.RECENT FINDINGS:In this article, we review recent evidence which suggests that the large-scale use of these tools outside of a research setting is not always helpful. Most are highly sensitive but not particularly specific and therefore cases may be 'overdiagnosed' but also missed. It may therefore be time for nutritional screening to evolve into a process which is able to better consider the cause of risk and requirements for nutrition support with referral criteria, defined goals and outcome measures and exit criteria using a 'measure, plot, think, act' approach embedded into physician rounds. Key challenges relate to improving compliance around nutritional screening within the hospital setting and comparison of nutrition risk between centres, as well as an understanding of the barriers which prevent nutritional screening and assessment from occurring.SUMMARY:It remains to be elucidated as to whether returning to a process which embeds nutritional assessment within the medical review rather than relying on a 'nutrition score' from a screening tool is a more effective way in which to identifying those patients that are malnourished or at risk of malnutrition during their hospital stay
- …
