Feeding Difficulty Among Chinese Toddlers Aged 1–3 Years and Its Association With Health and Development

Feeding problems are biopsychosocial in nature and have a great influence on children's growth. The aim of this study was to profile the status and possible influencing factors of feeding difficulty among normal Chinese toddlers, and to investigate its association with health and development. This study is a part of the Young Investigation (YI study) conducted in 10 cities in China. Data from 924 children aged 1–3 years were analyzed. Data on socio-demographic factors, feeding behaviors, self-reported diseases, and anthropometry parameters were collected. Blood samples were drawn to determine hemoglobin levels. Feeding difficulty was evaluated by the Montreal Children's Hospital Feeding Scale (MCH-FS). Ages and Stages Questionnaires, Third Edition (ASQ-3) were used to assess developmental progress. Multivariable analyses were performed to explore the potential associations. The mean total score of the MCH-FS was 35.21 ± 12.90 and the highest scored item was “acting up/making a big fuss during mealtimes.” Feeding difficulty occurred more often among children with picky eating behavior or whose caregivers once used the strategy of pre-mastication. Children with feeding difficulty had lower intakes of cereals, vegetables, and fruits, and were more likely to suffer from diarrhea (OR, 2.04; 95%CI: 1.32, 3.11) or constipation (OR, 2.04; 95%CI: 1.27, 3.24), but not anemia. Feeding difficulty was also negatively associated with weight, height, head circumference and mid-upper-arm circumference-related Z-scores (P all < 0.05). In addition, it was related to poorer fine motor skills, personal and social skills, and total scores of ASQ-3 (β, −9.00; 95%CI: −15.11, −2.89). Feeding difficulty assessed by MCH-FS showed a negative association with children's health and development, supporting the need for early identification.

An unexpected difficult airway due to an undiagnosed congenital lingual thyroglossal duct cyst in a neonate with gastrointestinal symptoms: A case report

Lingual thyroglossal duct cysts can be a rare cause of feeding difficulties in infants. Here, we describe a case of an undiagnosed lingual thyroglossal duct cyst in an infant with vomiting and feeding difficulty, who underwent surgery for Hirschsprung’s disease and had an unexpected difficult airway during anesthesia induction.

Recommendations and Outcomes for the Introduction of Complementary Foods for Children With Down Syndrome

Date Presented 04/13/21 The purpose is to begin to address the lack of consistent guidelines for when, and how, families should begin to introduce complementary foods for children with Down syndrome (DS). Semistructured interviews with 22 parents and 8 primary care providers were conducted and analyzed. Results indicated that no formal guidelines exist for this realm, and yet 17 of 22 children have experienced some level of feeding difficulty. Guidelines for feeding progression for this population are needed to improve feeding outcomes. Primary Author and Speaker: Erin Cochran Additional Authors and Speakers: Winifred Dunn

Does Severity of Brain Injury on Magnetic Resonance Imaging Predict Short-Term Outcome in Neonates Who Received Therapeutic Hypothermia?

Objective The National Institute of Child Health and Human Development (NICHD) magnetic resonance imaging (MRI) pattern of brain injury is a known biomarker of childhood outcome following therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy (HIE). However, usefulness of this classification has not been evaluated to predict short-term outcomes. The study aimed to test the hypothesis that infants with NICHD MRI pattern of severe hypoxic-ischemic brain injury will be sicker with more severe asphyxia-induced multiorgan dysfunction resulting in prolonged length of stay (LOS) following therapeutic hypothermia. We also evaluated the role of other risk factors which may prolong LOS. Study Design We retrospectively reviewed the medical records of 71 consecutively cooled neonates to examine the ability of MRI patterns of brain injury to predict the LOS. A neuroradiologist masked to outcomes classified the patterns of brain injury on MRI as per NICHD. Pattern 2A (basal ganglia thalamic, internal capsule, or watershed infarction), 2B (2A with cerebral lesions), and 3 (hemispheric devastation) of brain injury was deemed “severe injury.” Results Out of 71 infants, 59 surviving infants had both MRI and LOS data. LOS was higher for infants who had Apgar's score of ≤5 at 10 minutes, severe HIE, seizures, coagulopathy, or needed vasopressors or inhaled nitric oxide, or had persistent feeding difficulty, or remained intubated following cooling. However, median LOS did not differ between the infants with and without MRI pattern of severe injury (15 days, interquartile range [IQR]: 9–28 vs. 12 days, IQR: 10–20; p = 0.4294). On multivariate linear regression analysis, only persistent feeding difficulty (β coefficient = 11, p = 0.001; or LOS = 11 days longer if had feeding difficulty) and ventilator days (β coefficient 1.7, p < 0.001; or LOS increased 1.7 times for each day of ventilator support) but not the severity of brain injury predicted LOS. Conclusion Unlike neurodevelopmental outcome, LOS is not related to severity of brain injury as defined by the NICHD. Key Points

Novel manifestations of Farber disease mimicking neuronopathic Gaucher disease

Diagnosis of rare disorders requires heightened clinical acumen. When such disorders present with atypical or novel features, it adds to the diagnostic challenge. A 9-month-old female infant who had received a diagnosis of neonatal hepatitis due to cytomegalovirus infection at 2 months of age presented to our institute with developmental delay, fever, vomiting, feeding difficulty, breathlessness and features of elevated intracranial pressure due to hydrocephalus. Key examination findings with cholestatic jaundice as an early manifestation led to suspicion of type 4 Farber disease. Observation of hydrocephalus, hypertension, bilateral pinguecula and Erlenmeyer flask deformity of the femur were unusual findings for Farber disease. The child had few features (pinguecula, Erlenmeyer flask deformity and hydrocephalus) overlapping with Gaucher disease. Alternatively, prosaposin deficiency (Farber disease type 7) was another differential diagnosis. Diagnosis of Farber disease was confirmed by detection of foamy macrophages on skin biopsy and two homozygous missense variants in ASAH1 gene.

Varied Clinical Presentation and Management of Pediatric Vallecular Cyst

The aim of this article is to highlight the varied presentation and management of vallecular cysts. Three children with diagnosis of vallecular cyst presented in our department were reviewed retrospectively for clinical presentation, diagnostic tools and treatment options. All three cases presented with respiratory and feeding difficulty. Diagnosis in all the three cases was made with laryngoscopy (flexible/direct) and imaging. All three patients were treated by transoral approach aimed for excision of cyst using cold instruments. Postoperative period was uneventful and no recurrences were observed on the long-term follow up. Vallecular cysts should be considered as one of the differentials in children with respiratory distress and dysphagia in spite of being a rare anomaly. Direct transoral approach for excision of the vallecular cyst is recommended as a safe and reliable method with no recurrences till date. Keywords: Vallecular Cyst; Respiratory Distress; Dysphagia; Laryngoscopy

Differences Effectiveness Premature Infant Oralmotor Intervention (PIOMI) And Oromotor Stimulation (OMS) To Readiness Oral Feeding

Introduction: Premature birth is one of the biggest contributors to neonatal mortality and morbidity. It is difficult for premature infants to adapt to life outside the womb due to the immaturity of various organ systems, one of which is the suction reflex relevant to the readiness to oral feeding. Difficulty in oral feeding due to the weakness of sucking is a concern since it often delays the discharge of the infants from the hospital, negatively affects the relationship between mother and infants, and potentially causes eating disorders in children. Some of these reasons are the basis for early intervention to improve oral feeding ability. Interventions that can be carried out are PIOMI and OMS interventions Objectives: This research aimed at identifying the differences in effectiveness between PIOMI and OMS with respect to the readiness of premature infants to oral feeding in the perinatology division of KMC Hospital, Luragung Methods: The method used was a quasi-experimental research with pretest and posttest using a number of samples (N) = 32 respondents divided into two intervention groups respectively consisting of 16 respondents Results: The results indicated that PIOMI (Δ = 9.0, p-value = 0.000) and OMS (Δ = 7.3, p-value = 0.000) had an effect on the readiness of premature infants to oral feeding. PIOMI intervention had a greater difference that consequently, it was more effective than OMS intervention. The confounding factors affecting the readiness of premature infants to oral feeding were gestational age and body weight, while chronological age did not affect Conclusion: Based on the research results, it was suggested that nurses can use PIOMI intervention to make premature infants ready for oral feeding

Review of Food Intake Difficulty Assessment Tools for People with Dementia

This review aimed to summarise the validity and reliability of feeding difficulties assessment tools for Individual with dementia. PubMed, PsycINFO, MEDLINE, CINAHL and Scopus were searched for feeding difficulty measurements studies published between 1990 and 2019. Sixteen publications were included and identified three tools: Edinburgh Feeding Evaluation in Dementia (EdFED), Feeding Behaviour Inventory (FBI), and Feeding Difficulty Index (FDI). Results showed the EdFED was translated and tested in various languages. The EdFED and FDI demonstrated high content and construct validity. The FBI was not validated. The EdFED had high inter-rater reliability, with Cronbach’s alpha ranging from 0.75 to 0.90. The FDI and FBI showed moderate inter-rater reliability. Although the EdFED has been tested and widely used, unlike FDI, which addresses multi-aspects of feeding difficulty. The FDI have higher clinical utility but future research needs to test the psychometric properties of FDI to determine its effectiveness in assessing feeding difficulties.

Congenital Anomalies of the Gastrointestinal Tract

The gastrointestinal system anomalies in the newborn infants are not uncommon and are due to either embryogenesis defects or intrauterine vascular accidents resulting in a compromise of fetal blood circulation to specific system organs. The symptoms generally present within first 1–2 days of life and are mostly referable to intestinal obstruction, manifesting as vomiting, feeding difficulty and distension of abdomen. Other defects may have distinct signs and symptoms and variable time of onset. Some defects may be diagnosed antenatally during prenatal maternal care. The investigations include radiography, magnetic resonance imaging and ultrasound and in a majority of cases clinical presentation and plain radiography may provide adequate diagnostic information. The outcomes of surgical repair are variable and depend upon the original pathological defect. Here, the common anomalies are described with their clinical presentation, surgical repair techniques and outcomes.