“What if?”: Addressing uncertainty with families

Children with cancer and their families deal with uncertainty throughout their treatment course. Clinicians must help patients and families manage uncertainty by engaging them in discussions about their worries and fears. Too often, clinicians avoid or defer discussions about anticipated or worried‐about future events—the “what ifs.” Failing to engage in these conversations may lead to increased distress. We have developed a framework for having “what if” conversations with patients and families that enables providers to explore families’ informational and emotional needs. This framework may enable providers to improve families’ prognostic understanding, explore concerns, and examine preferences and goals of care.     

Non‐tuberculous mycobacterial lymphadenitis in healthy children: another “lifestyle disease”?

An increasing incidence of non-tuberculous mycobacterial (NTM) lymphadenitis has been reported in previously healthy children in the western world since about 1985. In this study we investigated the sociodemographic and individual characteristics of these patients. Information about patients was collected prospectively from 1977 to 1996. For comparison, an ad hoc group of hospitalized children with bacterial cervical lymphadenitis was chosen. In addition to individual characteristics, information was collected on the country of birth of the patients and their parents, and the socioeconomic characteristics of the domicile area. We identified 81 children with NTM, 14 with tuberculous and 192 with septic lymphadenitis. Significantly more parents of children with NTM than in either of the other two groups were Swedish-born and lived in privileged socioeconomic areas. CONCLUSION: The increase in NTM lymphadenitis in healthy children has taken place at the same time as the reported increase in atopic disease and asthma in childhood. Both groups of patients seem to come from favourable living conditions. It is speculated that NTM lymphadenitis, like asthma and certain other diseases triggered by the immune system, might be a "lifestyle disease".     

How does “Becoming Breastfeeding Friendly” work? A Programme Impact Pathways Analysis

Becoming Breastfeeding Friendly (BBF) is an initiative designed to track country readiness and progress to effectively scale up breastfeeding programmes. BBF includes a policy toolbox that has three components: the BBF Index (BBFI), case studies, and a five‐meeting process. Mapping pathways of how BBF was implemented and utilized enables contextually grounded interpretation of its impact on breastfeeding outcomes. We conducted a programme impact pathways (PIP) analysis to identify pathways and critical quality control points (CCPs) by which BBF can enable changes in policy, legislation, and implementation of breastfeeding programmes. A BBF PIP diagram was developed, and CCPs were identified through a literature review and an iterative interviewing process with BBF investigators. The PIP was revised after feedback from BBF's Technical Advisory Group. BBF pretesting in Ghana and Mexico informed the formative evaluation of the PIP. PIP analysis identified relevant pathways between BBF activities and outcomes. Eight CCPs that could facilitate or attenuate BBF to fully impact the scaling up of the breastfeeding programmes were identified: (a) committee formed and trained; (b) committee understands BBF and BBFI; (c) committee's ability to acquire data; (d) BBFI scores; (e) criteria used for prioritizing recommendations; (f) dissemination of recommendations; (g) policymaker's reactions and media coverage; (h) committee's motivation and effective teamwork throughout BBF. Ghana and Mexico's pretesting of BBF confirmed the CCPs and provided valuable insights on potential mechanisms of BBF impacts at the country level. To further validate the PIP, a policy analysis framework is being tested in Ghana and Mexico.     

Prognosis of infantile obesity: Is infantile obesity “benign” childhood obesity?

Background: Obesity occurring earlier than 2 years of age is categorized as “benign” childhood obesity. In other words, no treatment is required for this type of obesity, and its course can simply be followed without any particular intervention. The purpose of the present study was to determine whether early infantile obesity is actually benign childhood obesity. Methods: The stature (length) and weight growth distance curves and growth velocity curves were determined for an obese infant (patient A), of his parents in infancy, and of his younger sister to determine whether their obesity in infancy was the benign childhood obesity. These data were also compared with other obese infants and those of normal infants. Results: Patient A's weight growth velocity declined until the age of 6 months and was then constant from 7 months onward. Because patient A's weight growth velocity curve followed the same pattern as that seen in a normal infant, despite differing in degree, the reason why this patient became obese in early infancy was probably insufficient deceleration of his weight growth velocity compared to that of a normal infant. In addition, the weight growth patterns and growth velocities of his parents and young sister during infancy were similar to those of the patient. Conclusions: The present four subjects had benign childhood obesity. In addition, six other cases of infantile obesity have been encountered at the authors' pediatric outpatient clinic. The clinical characteristics of infantile obesity are discussed.     

“Am I doing this wrong?” Breastfeeding mothers' use of an online forum

As mothers seek out information around breastfeeding, many are turning to online message boards, listservs, or social media for advice. Babycenter.com , a parenting website with widespread use, hosts a Breastfeeding Support and Help community forum with over 140,000 users and more than one million conversation threads. The purpose of this study is to examine this online support forum to understand the information seeking and sharing practices of its users. We extracted a total of 258 original posts and 1,445 corresponding comments from Babycenter.com 's breastfeeding forum posted over a 10‐day period. Using content analysis, we coded the posts into 15 categories reflective of the types of information users were seeking. We then randomly selected 45 conversation threads across the most popular categories to further understand how users were sharing information. The most popular breastfeeding topics for which users sought out information included feeding challenges, supply issues, feeding schedule and duration, pumping, physical health, excretion issues, storing milk, nipple issues, and general breastfeeding questions. Participants elicited information from others using interviewing questions and built consensus around issues by agreeing with previous posts. They shared their knowledge and personal breastfeeding experiences and also provided encouragement to continue breastfeeding and overcome challenges. Online support forums are actively being used by breastfeeding mothers seeking information from others with similar experiences. This presents an important resource for breastfeeding mothers and may, therefore, be an important component of future breastfeeding interventions.     

Olive ingestion causing a false suspicion of relapsed neuroblastoma: A case of “oliveblastoma?”

Measurement of the urine catecholamine metabolites homovanillic acid (HVA) and vanillylmandelic acid (VMA) are the standard method for detecting disease recurrence in neuroblastoma. We present a case of abnormal concentrations of catecholamine metabolites that prompted investigations for relapsed neuroblastoma. However, further study revealed that the abnormal biochemistry was likely due to ingestion of olives. Olive ingestion should be considered when interpreting urine HVA and VMA results, and excluded if concentrations are unexpectedly abnormal.     

Is there a “complementary feeding cultural core” in rural Kenya? Results from ethnographic research in five counties

This investigation used data from focused ethnographic studies in five rural counties in Kenya to determine whether the concept of “special foods for infants and young children” exists in the different ethnic groups in these areas as an identifiable component of cultural beliefs and knowledge, as well as in practice, and whether they can be characterized as a “complementary feeding cultural core.” The concept of “cultural core foods” refers to the set of foods that have a central role in diets of a population and, as a consequence, also have significant social and emotional components. We used the ethnographic cognitive mapping technique of “free listing” and a qualitative 24‐hr recall of infants and young children (IYC) intake, with probing, to obtain data on caregivers' beliefs and behaviours. The results show that an IYC cultural food core can be identified in all of the counties. A related finding that supports the argument for an “IYC cultural core” with respect to appropriate foods for IYC is the clear cognitive consensus within sites about its content, although in practice, food insecurity and food shortage constrain household abilities to put their beliefs into practice. We conclude that interventions to improve IYC feeding in rural Kenya that build on the concept of “IYC cultural core foods” will be congruent with basic cultural ideas about managing IYC feeding and could take advantage of this cultural feature.     

“Are these adult doctors gonna know me?” Experiences of transition for young people with a liver transplant

Excellent survival rates in paediatric LTx have resulted in increasing numbers of young people transferring from paediatric to adult care. Understanding the mechanisms of successful transition is imperative for ensuring good long‐term outcomes and developing services for young people. Semi‐structured interviews were conducted with 17 young people (10 females; age range: 15.2–25.1 years). Eight were within 1 year of transferring to adult services; nine had transferred. Interviews were analysed using IPA. Analysis revealed two major themes in both pre‐ and post‐transfer groups: “relationships with healthcare professionals” and “continuity of care.” Young people experienced difficulty ending relationships with paediatric clinicians and forming new relationships with adult clinicians. They expressed frustrations over a perceived lack of continuity of care after transfer and a fear of the unknown nature of adult services. The importance of a holistic approach to care was emphasized. Interventions are needed to support young people in transition, particularly in ending relationships in paediatric care and forming new relationships in adult care. Young people need help to develop strategies to cope with the different approaches in adult services. Interventions to provide clinicians with skills to communicate and engage with young people are imperative.