Maternal complaints about feeding problems and anthropometric parameters of children with a diagnosis of pediatric feeding disorder

ABSTRACT Purpose: to describe the anthropometric parameters of children diagnosed with pediatric feeding disorder by a multiprofessional team. Methods: a retrospective clinical study conducted on 196 children on maternal complaints of feeding difficulties and a diagnosis of pediatric feeding disorder. Children with neurological diseases or having no pediatric feeding disorder diagnosis were excluded from the study. Weight and height data were obtained and parameters such as weight-for-age, length/height-for-age and body mass index for-age were analyzed, according to the recommendations of the World Health Organization. The two-proportion equality test was used and the level of significance was set at 0.05 (5%) in all analyses. Results: results showed mean (±Standard Deviation) values of 13.09±5.1 for weight (kg), 0.61±15.53 for height (cm) and 15.37±1.56 for body mass index (kg/m²). The results also showed that 87.2% of the children were within the adequate z-score for weight-for-age, 93.4% were within the adequate z-score for length/height-for-age, and that 88.8% had a normal z-score for-age for body mass index. Conclusion: the sample of children diagnosed with pediatric feeding disorder exhibited adequate anthropometric parameters for their age range.

A constituição da relação mãe-filha e o desenvolvimento dos transtornos alimentares / The constitution of mother-daughter relationship and the development of eating disorders

O presente estudo buscou compreender, por meio de abordagem qualitativa, como mães de adolescentes com transtornos alimentares vivenciaram o processo de cuidar de suas filhas desde a gestação até os dois anos de idade, procurando investigar se essas vivências relacionadas à maternidade guardam relação com o aparecimento futuro do transtorno. Foram entrevistadas seis mães de pacientes com anorexia nervosa, que estavam em seguimento ambulatorial em um serviço especializado. Os relatos maternos foram examinados pela análise de conteúdo. Os resultados evidenciaram dificuldades de sustentação (holding) por parte das mães, que acarretaram intenso sofrimento e sentimento de impotência diante das necessidades básicas das filhas. As crianças foram descritas como vorazes e insatisfeitas, sugerindo que teriam vivenciado dificuldades em assimilar o cuidado oferecido por suas mães em seus primeiros anos de vida. Desse modo, os resultados corroboram a importância de investigar as experiências infantis precoces para a compreensão da etiologia dos transtornos alimentares.

Based on a qualitative approach, the present study aimed to understand how mothers of adolescents eating disorders with experienced the process of raising their daughters from pregnancy to their second year of age, trying to investigate the influence of those maternity experiences on the development of disorder. We interviewed mothers of six patients with anorexia nervosa who were followed up at a specialized outpatient. Maternal reports were examined by content analysis. Results showed difficulties in holding by mothers, which led to intense suffering and feeling of powerlessness in the face of the basic needs of their daughters. Children were described as voracious and unsatisfied, what suggests that they might have experienced difficulties in coping with the care offered by their mothers in their early development experiences. Thus, results corroborate the importance of investigating early childhood experiences to understand eating disorders etiology.

The Effects of Multidisciplinary Approach for Children with Feeding Disorder and Failure to Thrive on Their Mothers

OBJECTIVES: The aim of this study was to determine whether intervention using a multidisciplinary approach affects maternal mental health, parenting stress, and sense of parenting competence in children with feeding disorder and failure to thrive (FTT). METHODS: Children with feeding disorder and FTT were randomized to the intervention group (N=11) or control group (N=8). We administered the Korean standardization of Parent Temperament Questionnaire for Children (K-PTQ) in both groups before intervention, and the Korean version of the Parenting Stress Index-Short Form (K-PSI-SF), Korean version of the Parenting Sense of Competence (K-PSOC), Korean version of the Beck's Depression Inventory (K-BDI), Korean version of the Beck Anxiety Inventory (K-BAI), and Korean version of the Mood Disorder Questionnaire (K-MDQ) in both groups before and after the intervention. RESULTS: In the intervention group, the K-BDI (p=.068), K-BAI (p=.068), and K-MDQ (p=.066) scores tended to show a decline, the K-PSI-SF scores for stress related to child learning showed a significant decline, and the K-PSOC scores for sense of parenting competence showed significant improvement. However, no significant changes were observed in the control group. CONCLUSION: Use of a multidisciplinary approach improved maternal mental health, parenting stress, and sense of competence. Comparison of these results with those of normal control will be necessary in a future study.

Deficiência de ferro em lactentes brasileiros com doença falciforme / Iron deficiency in Brazilian infants with sickle cell disease

OBJETIVO: Avaliar a deficiência ou sobrecarga de ferro em lactentes com doença falciforme, a fim de embasar a decisão de recomendar (ou não) a suplementação profilática de ferro nessa população. MÉTODOS: Estudo retrospectivo transversal envolvendo 135 lactentes menores de 2 anos (66 meninos e 69 meninas), com genótipos SS e SC (77/58), nascidos entre 2005 e 2006 em Minas Gerais. Os indicadores de uma possível deficiência de ferro foram: volume corpuscular médio (VCM), hemoglobina corpuscular média (HCM), saturação da transferrina (ST) e ferritina. Dezessete lactentes [12,6 por cento, intervalo de confiança de 95 por cento (IC95 por cento) 7,0-18,2 por cento] haviam recebido hemotransfusão antes da coleta dos exames. RESULTADOS: ST e ferritina estavam significativamente mais baixas nos lactentes com hemoglobina SC (p < 0,001). Quando dois indicadores foram utilizados para definir a deficiência de ferro (VCM ou HCM baixos mais ST ou ferritina baixas), 17,8 por cento das crianças (IC95 por cento 11,3-24,3 por cento) tinham deficiência de ferro, predominando naquelas com perfil SC (p = 0,003). Análise das crianças que não haviam sido transfundidas (n = 118) mostrou prevalência de ferropenia em 19,5 por cento. Constatou-se aumento de ferritina em 15 lactentes (11,3 por cento; IC95 por cento 5,9-16,7 por cento); a maioria havia sido transfundida. CONCLUSÕES: A maior parte dos lactentes com doença falciforme não desenvolve deficiência de ferro, mas alguns têm déficit significativo. Este estudo indica que lactentes com doença falciforme, principalmente aqueles com hemoglobinopatia SC, talvez possam receber ferro profilático; no entanto, a suplementação deve ser suspensa após a primeira hemotransfusão.

OBJECTIVE: To assess iron deficiency or overload in infants with sickle cell disease in order to support the decision to recommend (or not) iron prophylactic supplementation in this population. METHODS: Cross-sectional and retrospective study with 135 infants below 2 years old (66 boys and 69 girls), 77 with SS and 58 with SC hemoglobin, born between 2005 and 2006 in Minas Gerais, Brazil. Indicators of possible iron deficiency were: mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), transferrin saturation (TS), and ferritin. Blood transfusions had been given to 17 infants (12.6 percent, 95 percent confidence interval [95 percentCI] 7.0-18.2 percent) before laboratory tests were done. RESULTS: Ferritin and TS were significantly lower in SC infants (p < 0.001). When two indices were considered for the definition of iron deficiency (low MCV or MCH plus low ferritin or TS), 17.8 percent of children (95 percentCI 11.3-24.3 percent) presented iron deficiency, mainly those with SC hemoglobin (p = 0.003). An analysis of infants who were not given transfusions (n = 118) showed that 19.5 percent presented iron deficiency. Fifteen infants (11.3 percent, 95 percentCI 5.9-16.7 percent) presented increased ferritin; the majority had been transfused. CONCLUSIONS: Most infants with sickle cell disease do not develop iron deficiency, though some have a significant deficit. This study indicates that infants with sickle cell disease, mainly those with SC hemoglobin, may receive prophylactic iron; however, supplementation should be withdrawn after the first blood transfusion.

Mídia, comportamento alimentar e obesidade na infância e naadolescência: uma revisão / The press, alimentary behavior and obesity in the childhood and adolescence: a review / Prensa, comportamiento alimentar y obesidad en la infancia y adolescencia: una revisión

A obesidade pode ser definida como uma síndrome multifatorial, consistindo de alterações funcionais, de composição bioquímica e de estrutura corporal, caracterizadas pelo acúmulo de gordura subcutânea associada ao aumento do peso. No Brasil, observa-se a influência da mídia na valorização do modelo norte-americano como referência de modernidade, tornando o padrão alimentar mais permeável a mudanças, especialmente em crianças e adolescentes,estimuladas pela publicidade e também pela indústria, devido à produção abundante de alimentos práticos e saborosos. O padrão alimentar vem sendo modificado ao longo da história em função de vários aspectos, como facilidade de acesso e maior poder aquisitivo da sociedade moderna, que permitem maior ampliação do mercado consumidor e a diversidade dos produtos nas prateleiras. Assim, medidas preventivas, como o controle da propaganda de alimentos pela mídia e a inclusão da educação alimentar no currículo escolar, devem ser instituídas desde a infância, visando ao melhor manejo no controle da obesidade.

Obesity can be defined as a multifactorial syndrome. It consists of functional alterations in the body’s biochemical composition and structure, characterized by the accumulation of subcutaneous fact in combination with weight gain. In Brazil, the press influences the valuation of the North American model as a reference in modern times, turning the alimentary pattern more open to change, mainly in children and adolescents, stimulated by propaganda and by the industry, due to the abundant production of practical and tasteful food products. The alimentary pattern has been changing over time in function of different aspects, such as easy access and modern society’s greater purchasing power, allowing for further expansion of the consumption market, and the product range available in the shops. Hence, prevention measure like the control of food propaganda by the press and the inclusion of alimentary education on the school curriculum should be established since childhood, with a view to better management in obesity control.

Se puede definir la obesidad como un síndrome multifactorial, consistiendo de alteraciones funcionales, de composición bioquímica, y de estructura corporal, caracterizadas por la acumulación de gordura subcutánea asociada al aumento del peso. En Brasil, se observa la influencia de la prensa en la valorización del modelo norte-americano como referencia de modernidad, volviendo el patrón alimentar más permeable a cambios, especialmente en niños y adolescentes, estimuladas por la publicidad y también por la industria, debido a la producción abundante de alimentos prácticos y sabrosos. El patrón alimentar viene modificándose a lo largo de la historia en función de varios aspectos, como facilidad de acceso y mayor poder adquisitivo de la sociedad moderna, que permiten mayor ampliación del mercado consumidor, y la diversidad de los productos en las tiendas. Así, se debe instituir medidas preventivas como el control de la propaganda de alimentos por la prensa y la inclusión de la educación alimentar en el currículo escolar desde la infancia, con objeto de alcanzar mejor manejo en el control de la obesidad.

Aversión a los alimentos en la infancia: ¿fobia, obsesión o trastornos del comportamiento alimentario no especificado? / Food Aversion during Childhood: Phobia, Obsessive or Non-Specifi ed Eating Disorder?

Introducción: La aversión a los alimentos puede ser una manifestación del proceso normal de desarrollo o una expresión sintomática de varias entidades clínicas que generalmente aparecen durante la infancia. Su relación con la aparición temprana de trastornos de la conducta alimentaria no ha sido suficientemente estudiada. Métodos: Se describen 15 casos de pacientes (8 varones y 7 mujeres) entre 7 y 21 años, quienes consultaron al programa Equilibrio, de Bogotá, entre septiembre de 2003 y febrero de 2007, por aversión a ciertos alimentos y alta selectividad. Resultados: Todos presentaron aversión de tipo fóbico a ciertos alimentos, texturas, sabores o colores. Entre las motivaciones hubo quejas somáticas intestinales, temor a subir de peso y distorsión de la imagen corporal. La mayoría presentaba obsesiones o comportamientos ritualizados relacionados o no con la comida. Se identifi caron 6 casos de anorexia nerviosa (AN) prepuberal y 4 con AN de aparición posterior a la menarquia. Un paciente tenía una disarmonía del desarrollo (síndrome de Asperger) y otro presentaba una psicosis infantil. Conclusiones: La aversión fóbica a los alimentos durante la infancia podría considerarse un síntoma temprano de AN, aunque la preocupación explícita por el peso o las alteraciones en la imagen corporal no aparezcan y predominen las quejas somáticas del funcionamiento digestivo o la fobia a la comida. El trasfondo obsesivo-compulsivo estuvo presente en la mayoría de casos de estos pacientes con trastornos alimentarios de la infancia...

Introduction: Food aversion can be an expression of the normal developmental process or a symptomatic expression of several clinical entities that generally appear during childhood. Its relation with an early ED appearance has not been well studied yet. Method: 15 clinical cases of patients between 7 and 21 years of age are described. They consulted with the Equilibrio outpatient program in Bogotá, Colombia, between September 2003 and February 2007, presenting aversion towards certain food, and high selectivity since very early ages. The anxiety produced by eating and the secondary somatic manifestations were the main psychopathological characteristics. Results: They were 8 men and 7 women. They all presented with phobic aversion towards certain food, textures, tastes and/or colors from a very early age. In 6 of them those characteristics were associated with intestinal complaints, while in 10 of them fear of gaining weight and body image distortion were present. 13 out of the 15 patients presented with obsessions or ritualized behaviors either related with food or not. We identified 6 cases of prepuberal Anorexia Nervosa (AN) and 4 with AN that appeared after menarche. One patient had a developmental disharmony (Asperger syndrome), and another one had child psychosis. Conclusions: Food phobic aversion during childhood could be considered as an early AN symptom, even if the explicit worry over weight and body image is not present, and somatic worries about gastric functions and or food aversion dominate. The obsessive-compulsive background was present in most of these patients with childhood ED. These symptoms can be present in other developmental childhood pathologies...