Pediatric Feeding Disorders: Effectiveness of Multidisciplinary Inpatient Treatment of Gastrostomy-Tube Dependent Children

Effectiveness of multidisciplinary inpatient treatment of feeding-disordered children was sought through retrospective chart review of 40 gastrostomy-tube (i.e., G-tube) dependent children, ages 22 months to 7 years, with co-occurring medical conditions. Treatment effect analyzed from pre- and posttreatment measures of oral and G-tube caloric intakes resulted in a significant difference from admission to discharge for both oral intake, t(39) = 5.76, p < .001 (d = 1.02); and G-tube dependency, t(39) = 10.94, p < .001 (d = 2.03), with both showing strong treatment effects. Results indicated a highly reliable and valid method of treating severe pediatric feeding disorders.     

Estimated Prevalence and Care Pathway of Feeding and Eating Disorders in a French Pediatric Population

Feeding and Eating Disorders (FED) are mostly described in infants and adolescents but are less well-known in children. Information on the prevalence of FED in the general pediatric population is still limited. The aim of this study was to estimate the prevalence and the care pathway of FED in a population aged 0–18 years old, using the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 classification. Two physicians interviewed 401 families using a questionnaire including demographics, BMI, dietary behavior data, and age-appropriate screening tools. Qualitative and quantitative variables were compared using the Chi² test and Student’s t-test, respectively. After a headcount adjustment based on the French population by age group, the estimated prevalence rate was 3% [95%CI (1.7–5.1)] for Avoidant and Restrictive Food Intake Disorder (ARFID), and 9.7% [95%CI (7.2–13.0)] for Unspecified FED (UFED), which included other restrictive and compulsive FED. The median age for ARFID was 4.8 years (0.8–9 years), and 7.5 years (0.6–17 years) for UFED. The interviews did not identify cases of anorexia, bulimia, binge eating disorder, other specified FED, pica or rumination. Only 15.2% of children with an FED were receiving medical care. The development of validated pediatric screening tools, as well as the training of health professionals in children FED is necessary.     

Pediatric Outpatient Feeding Clinic

Background: Feeding disorders occur commonly in the pediatric population and vary in severity from picky eating to extreme food selectivity. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases, 10th Revision provide more inclusive diagnostic criteria for feeding disorders, but little is known about the actual referral population to an outpatient feeding clinic. In this investigation, the nutrition status, reason for referral, and related exploratory questions of outpatient referrals are detailed. Materials and Methods: Children aged 1–18 years were eligible for enrollment. Survey data collected included demographics, prior diagnoses, parental/caretaker complaint, mealtime duration, referral source, and food repertoire. Exploratory questions examined the impact of the feeding disorder on immediate family. Results: Ten percent of participants had a weight‐for‐height z score or body mass index score of ≤?2. The most common parental/caretaker chief complaint were poor nutrition, food refusals, and poor weight gain. The food repertoire included 15 or fewer items (7%), between 15 and 25 items (18%), or greater than 25 items (75%). The most positive responses to exploratory questions were mealtime frustration, lack of understanding by other family members, lack of access to appropriate treatment in a timely fashion, and inability to meet the child's feeding needs. Conclusion: Most referred infants and children were not undernourished. Despite this finding, most parents/caretakers were concerned about inadequate nutrition status and poor weight gain. Feeding disorders have an adverse effect on immediately family members. Revised diagnostic criteria should facilitate better identification of the broad spectrum of feeding disorders.     

Parental Satisfaction in the Adoption of Children with Learning Disorders: The Role of Behavior Problems

We sought to determine the extent to which children's behavior problems would mediate the relationship between children's learning disorders and adoption satisfaction using nationally representative data from 1,865 adoptive parents. We found that high levels of behavior problems, operationalized as internalizing and externalizing behaviors, occurred more frequently in children with learning disorders, supporting our mediational model. We concluded that it was the behavior problems, not the learning disorders, that were most problematic for parents. Implications for both pre‐ and postadoption services are highlighted.     

Childhood Overweight/Obesity and Pediatric Asthma: The Role of Parental Perception of Child Weight Status

Childhood obesity and asthma are on the rise in the U.S. Clinical and epidemiological data suggest a link between the two, in which overweight and obese children are at higher risk for asthma. Prevention of childhood obesity is preferred over treatment, however, in order to be receptive to messages, parents must perceive that their child is overweight. Many parents do not accurately assess their child’s weight status. Herein, the relation between parental perceptions of child weight status, observed body mass index (BMI) percentiles, and a measure of child feeding practices were explored in the context of asthma, food allergy, or both. Out of the children with asthma or food allergy that were classified as overweight/obese by BMI percentiles, 93% were not perceived as overweight/obese by the parent. Mean scores for concern about child weight were higher in children with both asthma and food allergy than either condition alone, yet there were no significant differences among the groups in terms of pressure to eat and restrictive feeding practices. In summary, parents of children with asthma or food allergy were less likely to recognize their child’s overweight/obese status and their feeding practices did not differ from those without asthma and food allergy.     

Behavioral Feeding Disorders in Young Children:

Young children with behavioral feeding disorders are commonly seen in occupational therapy practice. This paper, based on clinical experience with these children, presents an expanded frame of reference which may be utilized in treatment. The combined use of food as play and treatment of choice is addressed and viewed from learning, developmental, psychodynamic and humanistic perspectives. Possible etiologies of these specific feeding behaviors are discussed.     

Parental Problem Recognition and Help-Seeking for Disruptive Behavior Disorders

The Journal of Behavioral Health Services & Research - Millions of children across the USA have unmet mental health needs. When these include the disruptive behavior disorders...     

职业紧张与抑郁障碍

本文综述了职业紧张引起抑郁障碍的作用机制，介绍了研究职业紧张与抑郁障碍的方法及抑郁障碍导致的后果和经济损失。此外，还提出了综合性的干预措施。     

A Biopsychosocial Model of Normative and Problematic Pediatric Feeding

A comprehensive model is presented that (a) highlights factors that have been implicated in the development and maintenance of feeding problems in both normal and clinical populations; and (b) provides a framework for the prevention, management, and treatment of feeding problems across the range of physically healthy children to children with acute and chronic illnesses. Relevant literatures and feeding models were synthesized to present a comprehensive unified biopsychosocial model that may aid in the prediction and synthesis of information about feeding and eating in both normal and clinical populations and provide a framework for interdisciplinary research and intervention.     

NICU Treatment Team Function and Its Effect on Parental Stress

Through a literature review this paper explores the operation of the NICU treatment team. It examines how the team's smooth functioning and family focus can effectively help the family cope with the stresses encountered in the birth of an infant with a critical medical condition. The paper progresses through a discussion of the following areas: (a) parental reactions to the birth of an infant with a chronic condition, and the causes of stress on the family unit, (b) the NICU environment and its part in parental stress, (c) stress factors for NICU treatment team members, (d) hospital culture and reducing stress through teamwork, (e) the role of the occupational therapist as a collaborator in the neonatal intensive care unit, and (f) reducing parental stress through the teamwork of family-centered care. The author concludes that a smoothly functioning treatment team, incorporating the principles of family-centered care, is essential to reducing parental stress and empowering the parent to take an active part in their infant's care. Involving the parent as an active member in a treatment team where interdependence and cooperation are fostered enables the parent to become confident in their own skills. It enables the parents to feel that they have some control over the situation and have an important role to play in the NICU process.     

Diet and Pediatric Functional Gastrointestinal Disorders in Mediterranean Countries

Background: The increased intake of FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyol) rich foods has been suggested as a possible trigger of functional gastrointestinal disorders (FGIDs). Despite the high FODMAP content, the Mediterranean diet (MD) appears to have beneficial effects on health. Our aim was to evaluate whether the prevalence of FGIDs in different Mediterranean countries may be influenced by FODMAP consumption and adherence to the MD. Methods: A school-based, cross-sectional, multicenter study was performed in six countries in the Mediterranean area: Croatia, Greece, Israel, Italy, Macedonia, and Serbia. Subjects 4-18 years were examined in relation to their eating habits and the presence of FGIDs, using Rome IV criteria, 3-day food diaries and Mediterranean Diet Quality Index in Children and Adolescents (KIDMED) questionnaires. Results: We enrolled 1972 subjects between 4 and 9 years old (Group A), and 2450 subjects between 10 and 18 years old (Group B). The overall prevalence of FGIDs was 16% in Group A and 26% in Group B. FODMAP intake was significantly different among countries for both age groups. In both groups, no significant association was found between FGIDs and FODMAPs. Adherence to the MD in all countries was intermediate, except for Serbia, where it was low. In both groups, we found a statistically significant association between FGIDs and the KIDMED score (Group A: OR = 0.83, p < 0.001; Group B: OR = 0.93, p = 0.005). Moreover, a significant association was found between the KIDMED score and functional constipation (Group A: OR = 0.89, p = 0.008; Group B: OR = 0.93, p = 0.010) and postprandial distress syndrome (Group A: OR = 0.86, p = 0.027; Group B: OR = 0.88, p = 0.004). Conclusions: Our data suggest that the prevalence of FGIDs in the Mediterranean area is not related to FODMAP consumption, whereas adherence to the MD seems to have a protective effect.     

Parental Posttraumatic Stress Symptoms Due to Childhood Cancer and Child Outcomes: Investigation of the Role of Child Anger Regulation

This article examines whether children's anger regulation mediates the relation of cancer-related parental posttraumatic stress symptoms (PTSS) to the psychological adjustment of children with cancer. Children with cancer, and their parents (N = 199; 52.3% boys), completed measures of parental PTSS, child anger regulation, and child adjustment. Parental cancer-related PTSS was significantly associated with child adjustment and anger regulation. Children's anger regulation mediated the relation between parental PTSS and child behavioral and emotional difficulties. This suggests anger regulation as a possible target for intervention.     

Role of Postbiotics in Diet-Induced Metabolic Disorders

Although the prevalence of metabolic disorders has progressively increased over the past few decades, metabolic disorders can only be effectively treated with calorie restriction and improved physical activity. Recent research has focused on altering the gut microbiome using prebiotics, probiotics, and postbiotics because various metabolic syndromes are caused by gut microbial dysbiosis. Postbiotics, substances produced or released by microorganism metabolic activities, play an important role in maintaining and restoring host health. Because postbiotics have a small amount of literature on their consumption, there is a need for more experiments on short- and long-term intake. This review discusses current postbiotic research, categories of postbiotics, positive roles in metabolic syndromes, and potential therapeutic applications. It covers postbiotic pleiotropic benefits, such as anti-obesity, anti-diabetic, and anti-hypertensive qualities, that could aid in the management of metabolic disorders. Postbiotics are promising tools for developing health benefits and therapeutic goals owing to their clinical, technical, and economic properties. Postbiotic use is attractive for altering the microbiota; however, further studies are needed to determine efficacy and safety.     

Parenting Stress and the Utilization of Pediatric Services

Parents' level of stress as measured by the Parenting Stress Index is examined in relation to the utilization of pediatric medical services for children between the ages of 1 and 48 months The six categories of medical services considered were Well Visits, Sick Visits, Infections, Diarrhea and Vomiting, Traumatic Injuries, and Other Medical Services For the first 18 months of age no significant mean difference between stress groups and medical utilization was found Significant correlations and mean differences were found for the 19- to 24- and the 25- to 48-month age groups in relation to the traumatic injury criterion Moderate parenting stress is interpreted as potentially adaptive in relation to reducing traumatic injuries.     

The Role of Community in Pediatric Injury

Cultural variations between communities may impact injury rates, especially among children. We conducted a retrospective study of three communities in Israel using data from the Israel National Trauma Registry (1998-2007). Pediatric injury hospitalization rates in urban communities with varied levels of socio-economic status (low, medium, and high) were compared for all injuries and cause-specific injuries. Age-standardized and age-specific rates were calculated. Age-standardized injury hospitalization rates were lowest for the low socio-economic status (SES) community (299.7, 95% confidence interval [CI] 289.8-309.6) compared to the medium SES (658.2, 95% CI 629.1-687.3) and high SES (443.7, 95% CI 422.2-465.3) communities. Similar rates were observed for injuries from falls, transportation, accidental striking and intentional causes. For example, rate ratios for falls were 149.1 (95% CI 142.0-156.2), 340.8 (95% CI 319.5-362.1) and 245.7 (229.9-261.5) in the low, medium and high SES communities, respectively. Deviations from these overall trends were noted, however, for pedestrian injuries and burns that were relatively higher in the low SES community and injuries from motorized vehicles that were greater among children living in the high SES community. These results suggest that strong social capital is associated with reduced pediatric injury risks regardless of community wealth. However, targeted interventions for reducing injuries in at-risk populations that rely solely on injury rates may omit culturally distinct communities and overlook their uneven burden to the trauma care system.