Pediatric Pseudotumor Cerebri: Epidemiological Features.

Objective: The purpose was to study the epidemiological and clinical features of Pediatric Pseudotumor Cerebri; we especially evaluated age, sex, sexual maturity, weight, symptoms, duration of the episode, visual acuity, correlation with systemic diseases or drugs. Methods: We investigated a population of 40 children (80 eyes), aged between 2 and 18 years, that referred to our Centre (Città della Salute e della Scienza di Torino - presidio Ospedale Regina Margherita) from 2000 to 2018. All the patients were monitored with visual field exam, fundus exam and Frisen classification, pupillary reflexes, best corrected visual acuity, orthoptic exam. Then, the demographic characteristics, BMI (body max index) and weight changes, the correlation with systemic diseases or drugs, the Relative Afferent Pupillary Defect (RAPD), the VI cranial nerve deficit, the time required for the diagnosis, the modality of onset, the correlation between diagnosis delay and best corrected visual acuity, the resolution time and the probability of recurrence were studied. Results: We observed 2 age peaks in our population, one consisting of adolescents (aged between 11 and 14 years) and one consisting of younger children aged between 4 and 7 years, with a statistically significant correlation between age and BMI. The deficit of the VI cranial nerve and the diplopia were resolved within the first month, despite the longer time of resolution of the papilledema. Headache was the main onset symptom, but after reclassifying onset symptoms per weight classes, in overweight children, we found an increased variability of symptoms (dizziness, postural instability, photophobia, nausea, vomit, strabism and diplopia, visual fogging, drowsiness, irritability). Moreover, we found only one totally asymptomatic case, during a routine visit, in a 6 years old overweight child with Down syndrome. Conclusion: The Pediatric Pseudotumor Cerebri is, even nowadays, a little known pathology. To provide a correct diagnostic assessment, it will be imperative to recollect the epidemiological features of this disease.

OVERWEIGHT AND ASSOCIATED FACTORS IN CHILDREN AND ADOLESCENTS WITH PHENYLKETONURIA: A SYSTEMATIC REVIEW

ABSTRACT Objective: To verify the occurrence of overweight in children and adolescents with phenylketonuria and to identify possible causal factors. Data sources: A systematic review was performed in the SciELO, PubMed and VHL databases using the descriptors “Phenylketonurias”, “Overweight”, “Child” and “Adolescent”. Original articles conducted with children and adolescents, published between 2008 and 2018 in Portuguese, English or Spanish languages were included. Data synthesis: A total of 16 articles were identified and, after screening procedures, 6 studies were selected for the review. Overweight in children and adolescents with phenylketonuria was a frequent occurence in the studies included in this review, ranging from 7.8 to 32.6%. The female sex was the most affected by the nutritional disorder. Furthermore, a high caloric intake combined with a lack of stimuli to practice physical activities were main factors associated with the excessive weight in the population of interest. Conclusions: Excess weight can be considered a common outcome in children and adolescents with phenylketonuria. It is mainly caused by inadequate food consumption and sedentary lifestyle. The importance of early identification of nutritional disturbances in children and adolescents with phenylketonuria should be emphasized, in order to prevent associated chronic diseases and to promote health by encouraging continued healthy eating habits and the regular practice of physical exercises.

Importance of Agriculture Intervention inImproving NutritionalStatus of Women and Children: An Indian Scenario

Agriculture is the process of producing food, feed, fiber and many other desired products by the cultivation of certain plants and the raising of domesticated animals (livestock). The practice of agriculture is also known as “farming”, while scientists, inventors and others devote to improving farming methods and implements are also said to be engaged in agriculture. Subsistence farming is one in which the farmer farms a small area with limited resource inputs and produces only enough food to meet the needs of his/her family. To ensure good health and wellbeing, good nutrition is the key. Despite of various developments, lack of access to nutritious foods, negatively impact the health of women and children. Among the reasons advanced for the poor nutritional status of Indian women, an enduring explanation relates to the intra-household status of women. Several indicators of women’s status in the literature consistently rank women in the countries of South Asia as lower in comparison to their counterparts in Asia, Africa, Latin America and the Caribbean [1]. These indicators are used to measure nutritional imbalance resulting in under-nutrition (assessed from underweight, wasting and stunting) and overweight. Child growth is internationally recognized as an important indicator of nutritional status and health in populations.

Using Trials of Improved Practices to identify practices to address the double burden of malnutrition among Rwandan children

Objective:Low- and middle-income countries (LMIC) are increasingly experiencing the double burden of malnutrition. Studies to identify ‘double-duty’ actions that address both undernutrition and overweight in sub-Saharan Africa are needed. We aimed to identify acceptable behaviours to achieve more optimal feeding and physical activity practices among both under- and overweight children in Rwanda, a sub-Saharan LMIC with one of the largest recent increases in child overweight.Design:We used the Trials of Improved Practices (TIPs) method. During three household visits over 1·5 weeks, we used structured interviews and unstructured observations to collect data on infant and young child feeding practices and caregivers’ experiences with testing recommended practices.Setting:An urban district and a rural district in Rwanda.Participants:Caregivers with an under- or overweight child from 6 to 59 months of age (n 136).Results:We identified twenty-five specific recommended practices that caregivers of both under- and overweight children agreed to try. The most frequently recommended practices were related to dietary diversity, food quantity, and hygiene and food handling. The most commonly cited reason for trying a new practice was its benefits to the child’s health and growth. Financial constraints and limited food availability were common barriers. Nearly all caregivers said they were willing to continue the practices and recommend them to others.Conclusions:These practices show potential for addressing the double burden as part of a broader intervention. Still, further research is needed to determine whether caregivers can maintain the behaviours and their direct impact on both under- and overweight.

Body Size Preferences and Food Choice Among Normal and Overweight Mothers and Children in Malawi (P10-070-19)

Objectives Overweight in mothers and children in sub-Saharan Africa is rapidly increasing and may be related to body size preferences. The objective of this study was to measure mothers’ preferences for their own and their child's body size and how they relate to food choices. Methods We enrolled 271 mothers and their children (6–59 months) in Lilongwe and Kasungu Districts. Based on standard body-mass index and weight-for-height z-score cutoffs, 78 mothers (29%) were normal weight and 193 (71%) were overweight; 120 children (44%) were normal weight and 151 (56%) were overweight. Interviewers used a set of 7 adult female and 7 child body silhouette drawings and a semi-structured question guide to measure mothers’ perceptions of their own and their child's preferred and healthy body sizes and how their preferences affected food choices. We performed chi-squared tests comparing body size perceptions and grouped open-ended responses by weight status. Results Mothers’ selection of silhouettes that represented their body size preferences (67% normal weight, 68% overweight preferred overweight) and perceptions of a healthy body size (96% normal weight, 94% overweight selected overweight as healthy) did not differ by their weight status. A higher percentage of mothers of overweight than normal weight children preferred overweight child body sizes (70% vs. 48%, P = 0.003). Mothers’ perceptions of a healthy child body size (89% normal weight, 94% overweight selected overweight as healthy) did not differ by the child's weight status. To attain a larger body size, mothers said they could eat or feed the child larger quantities or more frequently and increase consumption of fatty/oily foods and drinks (such as sodas, sweetened yoghurt, and milk), but many cannot afford to do this. Conclusions Malawian mothers had strong preferences for overweight body sizes for themselves and mixed preferences for their children. Their desired strategies for increasing weight indicate that body size preferences may drive food choice but could be limited by cost. Funding Sources Drivers of Food Choice (DFC) Competitive Grants Program, funded by the UK Government's Department for International Development and the Bill & Melinda Gates Foundation, and managed by the University of South Carolina, Arnold School of Public Health.

Child healthcare nurses’ encounters with parents whose child is overweight

Nurses in the Swedish child healthcare system can make a difference by offering support to parents of children who are overweight or at risk of becoming so. Still, research concerning these nurses’ clinical practice when encountering parents whose child is overweight is inadequate. The aim of this study was to describe nurses’ clinical practice when encountering parents of an overweight child. Data were collected through interviews with 10 nurses, and a content analysis approach was used. The nurses’ clinical practice is described in relation to Olander’s theory: Individualising actions, Creating a dialogue, Documenting, and Focusing on normality. This study adds knowledge about nurses’ clinical practice in encounters with parents whose child is overweight. Also, it adds information on how an issue in a specific care situation may contribute to further understanding and use of an existing theory in caring science.

Tackling Childhood Overweight: Parental Perceptions of Stakeholders’ Roles in a Community-Based Intervention

Introduction. Collaborative efforts among communities, schools, parents, and health professionals are needed to prevent childhood obesity, which touches one third of Canadian youth. The purpose of this case study was to obtain parents’ experience and perceptions about stakeholder roles in a multidisciplinary community-based intervention aiming to tackle childhood overweight. Methods. Data were collected from semistructured interviews with 10 parents following their participation in a community-based program designed to help families with overweight children adopt a healthier lifestyle. Results and Discussion. All parents preferred a multidisciplinary health team to monitor their children’s health. They expect that a physician or a pediatrician could diagnose overweight, explain results to parents, and refer families to resources. The team could also include professionals from health and education such as nutritionists/dietitians, nurses, physical education teachers, psychologists, kinesiologists, and social workers. Parents’ own perceived role would consist of instructing and reinforcing their children about healthy behaviors, role modeling for a healthy lifestyle, and seeking for professional help when needed. Conclusion. Parents involved in a support group with overweight child consider their own role as crucial to help changing their family lifestyle. They also prefer a multidisciplinary team that can address different aspects of overweight/obesity. However, the physician was perceived as having the central role in mobilizing a group of stakeholders around youth with overweight/obese, including the parents. A further step would be to understand barriers and facilitators to collaboration among health professionals in childhood overweight prevention and treatment.

Developing the capacity of general practice staff to support healthier weight status in children

BackgroundLambeth has implemented a healthy weight care pathway including capacity building of multi-agency staff. Successes include being the only borough in the country to see statistical reductions in childhood obesity over 5 years; but the challenge of 39.2% of 10–11-year olds leaving primary school as overweight/obese persists. When families approach GPs to validate the National Child Measurement Programme feedback, challenges include interpretation and explanation of body mass index (BMI). GPs have also felt uncomfortable raising the issue in routine consultations.AimTo understand potential enablers to raising the issue of unhealthy weight in children in general practice.Method70 staff (GPs 58%; Nurses 25%; GP registrar/trainee 7%; and HCA/other 10%) completed a bespoke childhood obesity capacity building workshop (accredited by the Royal College of GPs). Using scenario-based activities and end of session written questionnaire we gathered: knowledge and perceptions of weight measures, role of diet, nutrition and physical activity, as well as current blocks and potential enablers for brief intervention.ResultsLess than 5% of participants were able to identify a very overweight child by visual inspection. Confidence in raising the issue was reported due to enhanced knowledge of energy intake, physical activity and provision of a BMI wheel (40%), new ways of raising the issue (30%), understanding of supportive services in Lambeth (30%).ConclusionSupportive measures identified within a whole systems approach including role of schools, government, public health and the CCG are informing future planning.