International Journal of Child Health and Nutrition

156-162

Authors: Chia-Liang Dai, Laura A. Nabors, Keith A. King, Rebecca A. Vidourek, Ching-Chen Chen, Nhung Hoang, Katherine G. Mastro

Background: The purpose of this study was to examine the feasibility of the Children’s Healthy Eating and Exercise Program (CHEE) in an afterschool program of an elementary school. Methods:Students in a low-income elementary school were recruited to participate in the program. Thirty-three children were in the intervention group. Twenty-four children in the comparison group were recruited from after school clubs in the same elementary school.The CHEE Program consisted of 18 sessions, featuring nutrition (20 min) and physical activity (40 min) lessons. Nutrition lessons were adapted from the Traffic Light Diet. Other lessons included MyPlate, my refrigerator, my lunchbox, and a healthy foods tasting activity. Multiple physical activities were utilized in the program including soccer, dance, relay races, tag, and other fun games. Data were collected at the beginning and end of the program. Results: Children in both groups reported eating more vegetables at the post-intervention measurement. Children in the intervention group indicated that they learned about healthy eating and new physical activities due to their participation in the program. Conclusions: Future studies are needed to discover barriers to behavior change as well as apply a more rigorous design to examine the impact of the CHEE Program.

170-178

Authors: Janavi Kumar, Tandalayo Kidd, Yijing Li, Erika Lindshield, Nancy Muturi, Koushik Adhikari

Childhood and adolescent obesity has increased drastically in the past 30 years. While this is troubling, there is also evidence of large disparities among certain ethnic groups such as African American and Hispanic children and adolescents. The Community-Based Participatory Research (CBPR) Model emphasizes a collaborative, co-learning, mutually beneficial, and community-partnered approach to research. Unique aspects of this model include viewing community members as equal partners in non-hierarchical teams, working together in a strengths-based, action oriented research process. This review consists of an investigation of the CBPR approach, its important tenets, and why such an approach may be more effective for childhood and adolescent obesity intervention program development, especially in stratified communities.

185-194

Authors: S.N. Prabhavathi, Jamuna Prakash

Iron deficiency anemia is a widespread nutritional problem. Children are particularly vulnerable due to poor maternal iron status and inadequate diet. Since iron plays a vital role in neurological development, its deficiency in early life can lead to altered cognition and motor development. Severe iron deficiency during infancy can affect the major processes such as myelination, development of neurotransmitter pathways, neural metabolism and neural plasticity. The present review intends to provide information on the various effects of iron deficiency during different stages of life cycle. Clinical trials conducted on both humans and animals have established that infants who suffer iron deficiency during the early years of life are known to be under risk for experiencing the long lasting effect of early iron deficiency in future years also. Follow-up studies conducted on infants showed that the anemic children continued to exhibit lower cognitive development compared to their non-anemic counterparts and also had difficulty in the development of motor control tasks. Hence, there is a need to identify and correct iron deficiency anemia during the early years of life to prevent possible future complications.

204-212

Authors: Joelle C. Glenn, Heather S. Walden, Eugenia Guzmán-Marín, María del Refugio Gonzalez-Losa, Antoinette McIntosh, Alyson G. Young, Jorge A. Hernandez

The objective of this study was to examine child, mother, and environmental factors associated with undernutrition in children less than five years old in a Maya community in Yucatan, Mexico. This investigation was designed as a case-control study. All cases (n=42) of undernutrition were included, and a sample of 52 controls was randomly selected from the study population. The frequency of investigated exposure factors was compared between cases and controls by using logistic regression. Undernutrition was associated with child’s age (> 36 months old; OR = 3.53; 95% CI = 1.04, 18.40) and mother’s marital status (married; OR = 0.29; 95% CI = 0.09, 0.90). The odds of undernutrition were 2.81 times higher in children infected with Giardia spp, but this association was not significant (P = 0.18) after controlling for child’s age and mother’s marital status. In conclusion, child’s age and mother’s marital status were associated with child undernutrition in study subjects. Futures studies on undernutrition in children should examine more carefully how mother’s marital status alone or in combination with other factors (e.g. socio-economic, psychological factors) can influence child nutrition.

114-123

Authors: Mahama Saaka, Sofo Mutaru

Objective: The main aim of the study was to identify factors contributing to positive deviance in growth of children in rural communities of Northern Ghana. Methods: Weassessed factors contributing to nutritional positive deviance among rural poor households by comparing household feeding care practices and health seeking behaviour in families with normal children (that is, neither stunted nor wasted) with children having at least one form of under nutrition. Results:The prevalence of stunting and wasting was 28.0 % (CI: 25.3 - 30.9), and 10.5 % (CI: 9.0 - 12.3) respectively. Multivariable logistic regression adjusted for cluster sampling showed that positive deviant children (that is, neither wasted nor stunted) were 2.4 times more likely to have taller (
160 cm) mothers [AOR 2.38; 95% CI (1.83 - 3.10)]. Female children were significantly more likely to be positive deviant [AOR 1.44; 95% CI (1.17 - 1.77)]. Households using salt of adequate iodine content were more likely to have positive deviant children [AOR 1.36; 95% CI (1.03 - 1.80)]. Conclusion and Recommendation:Positive deviance in child growth was characterized by taller mothers, being a female child, high maternal nutrition knowledge and being resident in the Upper West Region. The persistent high levels of child under nutrition in Northern Ghana can be mediated through a sustainable focused intervention strategy to improv e maternal nutrition.

130-138

Authors: Wendy Gwirtzman Lane, Howard Dubowitz, Susan Feigelman, Gina Poole

Background:Food insecure children are at increased risk for medical and developmental problems. Effective screening and intervention are needed. Methods:Our purpose was to (1) evaluate the validity and stability of a single item food insecurity (FI) screen. (2) Assess whether use may lead to decreased FI. Part of a larger cluster randomized controlled trial, pediatric residents were assigned to SEEK or control groups. A single FI question (part of a larger questionnaire) was used on SEEK days. SEEK residents learned to screen, assess, and address FI. A subset of SEEK and control clinic parents was recruited for the evaluation. Parents completed the USDA Food Security Scale (“gold standard”), upon recruitment and 6-months later. Validity, positive and negative predictive values (PPV, NPV) was calculated. The proportion of screened families with initial and subsequent FI was measured. Screening effectiveness was evaluated by comparing SEEK and control screening rates and receipt of Supplemental Nutrition Assistance Program (SNAP) benefits between initial and 6-month assessments. Results:FI screen stability indicated substantial agreement (Cohen's kappa =0.69). Sensitivity and specificity was 59% and 87%, respectively. The PPV was 70%; NPV was 81%. SEEK families had a larger increase in screening rates than control families (24% vs. 4.1%, p<0.01). SEEK families were more likely to maintain SNAP enrollment (97% vs. 81%, p=0.05). FI rates remained stable at approximately 30% for both groups. Conclusions:A single question screen can identify many families with FI, and may help maintain food program enrollment. Screening may not be adequate to alleviate FI.

148-155

Authors: Antonio Imbasciati

This paper clarifies the meaning of Perinatal Clinical Psychology by removing the prejudice and the stereotypes that unfortunately pervade children health care facilities still nowadays. The author goes over the basic principles that neuroscience has recently demonstrated in the development of the brain from the fetus to the infant, the child and the adult. The brain is self-generating through experience and not on the basis of genome. Epygenetics accounts for it. The brain needs to learn so as to be able to develop. Nobody has a brain that is the same as anybody else’s and therefore nobody has a mind that is the same as anybody else’s. The brain generates the mind and, in turn, the mind regenerates the brain in a ceaseless feedback. The experience that generates and renews the brain continuously comes from interpersonal relationships. The greatest incidence of this kind of development comes from the relationships with the parents and the caregivers and depends on the emotional moment of the relationship. This opens up transgenerational perspectives. The quality of the mind (and the brain) of the parents and caregivers produces the quality of the mind of the children. The latter, in turn, become adults, condition the mind of their children in cascade effectfrom one generation to the following. This transmission can produce an improvement but also a worsening for the future generations. As a consequence, Perinatal Clinical Psychology becomes important for prevention and psychological support to the children and the families at risk

67-77

Authors: Keith E. Williams, Maria Blanques Petty, Maria Arlete M. Schimith-Escrivão, Kyong-Mee Chung, Woo Hyun Jung, Helen M. Hendy

The present study considered three samples of mothers from Brazil, South Korea, and the United States to determine whether mothers demonstrate a consistent pattern of feeding practices associated with child overweight. Participants included 1204 mothers of children 6-10 years old. Mothers completed questionnaires to report their children's demographics and their feeding practices with the Parent Mealtime Action Scale (PMAS). The South Korean children showed significantly less obesity (10.4%) than children from Brazil (17.0%) or the United States (19.6%). Confirmatory factor analysis for mothers from all three samples revealed good fit for the same nine PMAS dimensions of feeding practice. Hierarchical multiple regression revealed that after taking into account child age and gender, heavier child weight was found associated with more Fat Reduction and less Insistence on Eating by mothers from all three samples. Results from past experimental research suggest that these two maternal feeding practices would be counter-productive for teaching children's self-regulation of diet and weight management. Alternative maternal feeding practices are suggested.

84-92

Authors: Susanne Georgsson Öhman, Christina Sandberg

Background: Premature infants are at increased risk of developing Gastroesophageal Reflux Disease (GERD), which for these children is associated with a number of severe symptoms. There is great need for effective instruments and clear symptom criteria to assess the presence and degree of severity of GERD. Aim: To develop and pilot test an observation instrument for early detection of symptoms of GERD in premature infants. Method: A combination of three research methods was used – systematic literature review, observation instrument development and a pilot test. Results: The systematic review identified specific symptoms of GERD. The development of the observational instrument started with the establishment of concordance between the criteria of symptoms according to the literature review and to NIDCAP, “Newborn Individualized Developmental Care and Assessment Program”. In the pilot test the criteria of symptoms were revised by comparing the result and the criteria between infants that clinically were estimated to have had a reflux problem and the ones who did not. Conclusion: An observation instrument was developed. The clinical evaluation by a pilot test showed that the instrument could be useful to record significant symptoms and combinations of symptoms that may occur in premature infants assessed as having reflux problems.

99-107

Authors: Shahzad Akram, Eleni Simatou, Jan-Bernd Stukenborg, Lars Hagenäs, Olle Söder, Zulfiqar A. Bhutta

Background: Foeto-placental growth is regulated by a complex balance of growth promoting and growth inhibiting factors and hormones, namely the insulin-like growth factors (IGF) and the intracellular caspase proteins. Changes in the IGF-axis appear to affect this balance, with deficiencies possibly triggering apoptosis. Aim: To ascertain levels of apoptosis in the placenta of infants born small for gestational age (SGA) and appropriate for gestational age (AGA), comparing samples from two population groups, Pakistani and Swedish, in an attempt to better understand the mechanism behind foetal-placental growth restriction. Methods: Placental samples were taken immediately following delivery in both Karachi and Stockholm. In total 36 samples were included for further analysis (Pakistani: SGA n = 12, AGA n = 12; Swedish: SGA n = 7, AGA n = 5). Protein extraction was conducted for cell-death ELISA, and the remaining tissue samples were then paraffin embedded for further immunohistochemical and immunoflourescent analysis, looking at the apoptotic proteins, p53, caspase 8, and caspase 3. Furthermore, we compared maternal and newborn anthropometry between populations. Results: A higher apoptotic index, for caspase 8 and caspase 3, was seen in the Pakistani samples, as compared to the Swedish samples (p<0.01). TUNEL assays showed higher levels of apoptosis in the Pakistani population as compared to the Swedish population (p<0.01). Cell death ELISA analysis showed greater apoptotic activity in placenta from the Pakistani population as compared to the Swedish groups (p<0.05) as well as increased apoptotic activity in the SGA groups as compared to the AGA groups within each population (ELISA, p<0.05). No differences were seen in p53 levels as assessed by immunohistochemistry. Pakistani mothers were, on average, shorter than their Swedish counterparts (p<0.01).Conclusion: Increased apoptotic activity in placenta of the Pakistani population, as compared to their Swedish counterparts, may be associated with decreased foetal-placental growth seen in this population, particularly in babies born SGA. These findings, along with previously published results of the IGF-axis, and birth weight outcomes, suggests that lower IGF levels may be involved in the extracellular triggering of apoptosis, through caspase 8. This may further suggest a possible mechanism of foetal-placental growth restriction.

1-10

Authors: Emre Yanikkerem, Semra Ay, Selda lldan Çalim

The aim of the study was to identify the effect of prenatal smoking on mother and newborn health. The study was carried out in 700 women, who delivered at Merkez Efendi Maternity and Children’s Hospital between 1st January, 2011 and 31st December, 2011. Of the sample of women, 15.6% were current and 7.3% were quitting smokers. Women who continued smoking during pregnancy lived in households with husband who smoked and had higher rates of depressive symptoms and pregnancy included hypertension. Smoker women more likely reported to expose physical violence during pregnancy by their partner. Meconium in amniotic fluid was associated with women smoking status. Newborns who were exposed to tobacco smoke prenatally had deficits in weight (-186.6 gr), height (-0.9 cm) and head circumference at birth (-0.6 cm). In the study when women quit smoking during the first trimester, their infants have anthropometric measures similar to infants of nonsmokers. Smoking during pregnancy was related to low birth weight, height, and with small head circumference. Smoking cessation during pregnancy may have a greater impact on baby anthropometrics measures which were similar to infants of nonsmokers. To protect the health of their future unborn children, it would be optimal to target all women of reproductive age to quit smoking before they consider becoming pregnant

17-26

Authors: Uchendu O. Uchendu, Patrick Leblanc, Jude M. Thomas, Ossama M. Maher, Yesenia Morales, Belen Fineza

Background: Diabetes mellitus (DM) is the commonest complication of pregnancy, negatively impacting mothers and fetuses. Few studies suggest amelioration of negative outcomes of DM-associated pregnancies in recent years, due in part to improved care. But increasing prevalence of overweight in developed countries is also affecting many women of childbearing age with concomitant poor glycemic control especially in pregnancy. Hyperglycemia, even at sub-diabetic levels, is associated with increased risk of macrosomia and Cesarean section. There is evidence demonstrating that outcomes of DM-associated pregnancies are similar with those characterized by hyperglycemia of sub-diabetic levels. Perhaps, improvement of care for DM-associated pregnancies on one hand, and the impact of obesity epidemic may have changed the relative frequencies of negative outcomes typically reported for infants of diabetic mothers (IDMs) compared with controls. Aims/Objective:We re-evaluated the relative frequencies of negative outcomes of pregnancies complicated by DM compared with non-diabetic pregnancies. Method/Design: A retrospective cohort analysis was conducted. Result: There were 50 diabetic and 83 non-diabetic mother-infant pairs. Mothers with DM-associated pregnancies had increased risk of delivery by C/Sxn, macrosomic babies, admission to NICU and prolonged hospitalization. Only IDMs had documented birth defects. Notable improvements over previous studies for IDMs include similar gestational ages at delivery and excellent APGAR scores in both groups. Conclusion: IDMs still have higher frequencies of negative outcomes compared with controls but some improvements are noteworthy and should provide impetus for efforts at reducing prevalence of obesity while improving care for DM-associated pregnancies

41-47

Authors: Gregory J. Privitera, Taylor E. Phillips, Melissa Misenheimer, Robert Paque

Obesity has become a growing global concern. Evidence indicates that ecological factors are most predictiv e of obesity among children, and that a new strategy, referred to as emolabeling, may effectively address ecological factors, although the extent to which it can influence food choice is not yet known, but tested here. Specifically, we tested the hypothesis that children aged 3 to 11 years will use emolabels, or emotional correlates of health (i.e. healthy-happy, unhealthy-sad), to make healthy food choices. A cross-sectional design was used with two phases. In Phase 1, children were taught how to use emolabels with a “faces of health” lesson. In Phase 2, children made choices between containers that were laid out on a large table in pairs and varied by taste (tastes good, no information), social norms (popular, not popular), branding (image of a minion, no image), or preference (told what food was in each container). A control pair was labeled with only emoticons. The order and presentation of the containers were counterbalanced for each variation. Results showed that a significant proportion of children in the pre-literacy and the early literacy grades used emoticons to specifically make healthy food choices in each variation (p < .05 for all tests), except when children were told what foods were in the containers. In all, emolabeling effectively influenced food choices for healthy foods among children aged 3 to 11 years, more so than labeling for taste, social norms, and branding, but not preference

55-59

Authors: Fabíola I. Suano de Souza, Heitor Pons Leite, Walter Jacob Chwals, Werther Brunow de Carvalho

Objective: To report a case of a child interned in an ICU of a University Hospital who developed refeeding syndrome, and to review the specific literature pertinent to this area. Case Report: An eight year-old, previously healthy, male patient was admitted for necrotizing pneumonia. On admission the child had a z-score of weight for height of 0.38 and height for age of -0.74. Following 60 days’ hospital admission he had lost 27.5% of initial weight. Enteral tube feeding, with an energy intake equivalent to the basal metabolic rate plus 20% for stress, was initiated and gradually increased during the stabilization phase. After receiving 2000 kcal/day for 5 days, hypophosphatemia was detected in association with an increase in hepatic enzymes and hyperglycemia. No concomitant worsening of the white blood count or evidence of inflammatory activity was present. These alterations were accompanied by an increase in pulse rate and body temperature, thereby leading to a diagnosis of refeeding syndrome. Energy intake decreased to 1520 kcal/day, resulting in a marked improvement of the laboratorial parameters in less than a week. Conclusions: Refeeding syndrome is a potentially dangerous complication of increased caloric administration in critically ill pediatric patients. Early recognition and appropriate adjustment of nutritional support is important to avoid the serious consequences which may ensue if this condition is left untreated