Subglottic cysts in infants: a report of 3 cases and literature review / 临床耳鼻咽喉头颈外科杂志

Subglottic cyst is a rare cause of laryngeal tinnitus in infants and young children, and only a few cases have been reported at home and abroad. In this paper, we report the clinical characteristics and treatment experience of three cases of subglottic cysts in Children's Hospital of Nanjing Medical University. All the 3 childrem were prematurechildren, with a history of tracheal intubation, and the main symptoms were coughing and wheezing.Electronic nasopharyngolaryngoscopy revealed spherical neoplasm under the glottis. Neck computed tomography （CT） showed a slightly hypodense shadow with poorly defined borders, and no significant enhancement was observed after enhancement. Under the self-retaining laryngoscope, the new organisms were clamped and nibbled, and the cyst wall was cauterized by low temperature plasma. There was no recurrence in postoperative follow-up.

Consensus recommendations on the evaluation and treatment of laryngotracheal anomalies in infants and young children / 临床耳鼻咽喉头颈外科杂志

Infants with laryngotracheal anomalies are clinically manifested as stridor or noisy breathing, choking, hoarseness, feeding difficulties, and cyanotic spells, followed by developmental and growth retardation and other health issues; in severe cases, patients may present with severe dyspnea, which is associated with high mortality. A timely diagnosis as well as appropriate strategy for laryngotracheal anomalies is still challenging for pediatric otolaryngologists. This consensus statement, evolved from expert opinion by the members of the Pediatric Otorhinolaryngology Professional Committee of the Pediatrician Branch of the Chinese Medical Doctor Association, provides comprehensive recommendations and standardized guidance for otolaryngologists who manage infants and young children with laryngotracheal anomalies in evaluation and treatment based on symptomatology, physical and laboratory examinations.

Children Exposed to Interparental Violence: A Study of Portuguese Children from 7-9 Years of Age / Niños expuestos a violencia interparental: un estudio de niños portugueses de 7 a 9 años

Abstract Introduction: Exposure to interparental violence is a type of child maltreatment linked to a higher risk of physical and mental health problems. This research considers the experiences of young Portuguese children exposed to interparental violence. The goal is to explore the associations between interparental conflict in children, their perceptions of conflict properties, threat, self-blame, and the relationship with their parents. Method: The research protocol was applied to 888 Portuguese children between 7 and 9 years of age, of whom 123 are victims of interparental violence. Results: The results showed that witnessing interparental conflict is positively correlated with children's self-blame and insight into conflict properties and negatively correlated with children's insight into the parent-child relationship. Conclusion: These results provide strong support for the hypothesis that witnessing interparental conflict is associated with adverse outcomes in young children. Findings highlight the importance of identifying children exposed

Resumen Introducción: La exposición a la violencia interparental es un tipo de maltrato infantil, y está relacionada con mayor riesgo de desarrollo de problemas de salud física y mental. Esta investigación analiza las experiencias de los niños portugueses expuestos a la violencia interparental. El objetivo es explorar la relación entre el conflicto interparental en los niños, sus percepciones sobre las propiedades del conflicto, la amenaza, la culpabilidad y la relación con sus padres. Método: Se ha aplicado el protocolo de investigación a 888 niños portugueses de entre 7 y 9 años, no víctimas (n = 765) y víctimas de la violencia interparental (n = 123). Resultados: Los resultados mostraron que presenciar el conflicto interparental está positivamente asociado a la percepción de culpabilidad de los niños y la percepción de las propiedades del conflicto y negativamente correlacionada con su percepción de la relación padre-hijo. Conclusión: Estos resultados soportan la hipótesis de que presenciar un conflicto interparental está asociado al desarrollo de problemas en niños pequeños. Los resultados destacan la importancia de identificar a los niños que han presenciado el conflicto interparental para desarrollar programas de intervención adecuados.

Advances in research related to severe pertussis in infants and young children / 中华实用儿科临床杂志

Pertussis is a highly contagious respiratory disease.Although widespread vaccination has greatly reduced the incidence of pertussis, there was a " recurrence of pertussis" in the past 30 years, and pertussis outbreaks occurred in some areas.Infants who have not been vaccinated or have not completed the full course of immunization suffer from more severe pertussis infections.Because of the atypical symptoms of young infants, missed diagnosis and misdiagnosis often occur, and pertussis cannot be diagnosed and treated in time.As a result, they can easily develop into severe pertussis or even die.In this article, recently published research on severe pertussis are summarized, so as to provide guidance for the clinical diagnosis, treatment, prevention and basic scientific research of severe pertussis.

A follow-up study on the outcome of 2 to 5 years old children with asthma at school age / 国际儿科学杂志

Objective:To investigate the outcome of asthma in young children after 3 years and the factors associated with the outcome.Methods:A total of 494 children aged 2 to 5 years with asthma diagnosed in 5 hospitals in Beijing from 2016 to 2017 were followed up by telephone using questionnaire survey.Information on the asthma attack, the disease control level, and the comorbidities of allergic diseases in the past 3 years was collected and analyzed.Results:Questionnaires were conducted in 387 children, including 261 males(67.4%)and 126 females(32.6%). Two hundred and forty-six patients(63.6%)had no any asthma symptom(remission) within 3 years, while 141 patients(36.4%)were found with asthma symptom(without remission). The main symptoms were as follows: wheezing in 116 cases(82.3%), recurrent cough in 59 cases(41.8%), shortness of breath in 45 cases(31.9%), chest tightness or waking up at night due to wheezing in 22 cases(15.6%). The causes of asthma attack were respiratory tract infection in 80 cases(56.7%), allergen exposure in 46 cases(32.6%), climate change or cold air stimulation in 59 cases(41.8%), strenuous exercise in 36 cases(25.5%), and irritating odor in 3 cases(2.1%). One-way anova analysis showed that significant difference( P<0.05)was respectively observed in age at follow-up, postnatal tobacco smoke exposure history, repeated respiratory tract infection before asthma onset, personal allergy history, snoring, allergic rhinitis, allergic rhinitis within 1 year, allergic conjunctivitis within 1 year between the remission group and without remission group.Multivariate unconditional logistic regression analysis showed that tobacco exposure after birth, allergic rhinitis and allergic conjunctivitis within 1 year were independent risk factors for the continuation of asthma symptoms to school age( P<0.05). Conclusion:Till the school age, more than 1/3 children still had asthma symptom and the risk factors for the unalleviated symptom were postnatal tobacco exposure, allergic rhinitis within 1 year and allergic conjunctivitis within 1 year.

Carbon dioxide laser treatment of facial papilloma in children: case report and literature review / 口腔疾病防治

Objective@#To investigate the feasibility of using a carbon dioxide(CO2) laser in the treatment of facial papilloma in children and to evaluate its curative effect and prognosis.@*Methods @#A case of pediatric facial papilloma treated with a CO2 laser was reported, and the effects of this disease and CO2 laser treatment were reviewed and analyzed in combination with the literature. @* Results@#Under general anesthesia, the lesion tissue of the left lip was excised for pathological biopsy, and the diagnosis was maxillofacial papilloma. The lesions were surgically ablated in stages with a CO2 laser, and erythromycin ointment was applied to the surgical incision after surgery. A total of three rounds of CO2 laser treatment were performed for 3 treatment courses. The child had no complications during or after the operation, the facial appearance was significantly improved, and there was no sign of recurrence during the 6-month follow-up. A literature review showed that CO2 lasers have been widely used in the excision of various surface lesions. In clinical practice, continuous CO2 laser with power of 10-50 W and wavelength of 10.6 μm is used to treat superficial tissue lesions, which can achieve accurate vaporization resection of diseased tissue, less bleeding and a good prognosis.@* Conclusion@#CO2 laser was accurate and minimally invasive for the removal of facial papilloma in children.

Effect of fluoride varnish, glass ionomer and resin sealant on the prevention of pit and fissure caries in young children / 口腔疾病防治

Objective @# To study the effect of fluoride varnish, glass ionomer and resin sealant on the prevention of pit and fissure caries in young children, and to identify an a method to reduce the sensitivity of operation technique to prevent pit and fissure caries in young children with limited moisture isolation.@*Methods@# A self-control design was used to select 370 young children aged 3 to 5. Eight molars in the mouth were distributed in four quadrants, and each quadrant was randomly allocated to the blank group, fluoride varnish Duraphat group, glass ionomer GC FujiⅦ group, and resin ClinproTM Sealant group. The retention rate of pit and fissure sealant and the incidence of primary molar caries were observed in the 6th, 12th, 24th and 36th months respectively.@* Results @# In the 6th month, 12th month and 24th month, there were no significant differences in the material retention rate between the GC Fuji Ⅶ group and ClinproTM Sealant group. In the 36th month, the retention rate of the ClinproTM sealant group was better than that of the GC Fuji Ⅶ group (P < 0.05). In the 6th month, the caries incidence in the Duraphat group, GC Fuji Ⅶ group and ClinproTM sealant group was significantly lower than that in the blank group (P < 0.001). There was no significant difference between the Duraphat group, GC Fuji Ⅶ group and ClinproTM sealant group. In the 12th month, 24th month and 36th month, the incidence of caries in the GC Fuji Ⅶ group and ClinproTM sealant group was lower than that in the Duraphat group and blank group (P < 0.001), but there was no significant difference between the blank group and Duraphat group, and there was no significant difference in caries incidence between the GC Fuji Ⅶ group and ClinproTM sealant group.@*Conclusion @#The GC Fuji Ⅶ and ClinproTM sealant treatments continuously and effectively prevented pit and fissure caries compared with simple fluoride application. However, in cases of limited cooperation and poor moisture isolation in young children, the preventive measures of glass ionomer pits and fissure sealants (GC Fuji Ⅶ) are simpler and more feasible.

Relationship between maternal characteristics and stunting in children aged 0 to 23 months in the Philippines

@#Introduction: Stunting is the most prevalent form of child malnutrition worldwide, and is the best overall indicator of growth. This study aimed to determine the relationship between maternal characteristics and nutritional status of children aged 0-23 months based on their length/height-for-age. Method: The study used data from the 2015 Updating Survey conducted by the Philippines’ Food and Nutrition Research Institute – Department of Science and Technology. It employed a stratified multi-stage sampling technique covering all regions in the Philippines. Mothers (n=5,254) of sampled children 0-23 months were the respondents of the Maternal Health and Nutrition survey. The length-for-age z-scores (LAZ) of children and maternal characteristics were analysed. Rao-Scott Chi-square test was used for association analysis. Logistic regression was performed for model fitting. Results: A quarter (25.2%) of children aged 0-23 months in the Philippines at the time of the survey were stunted, with the highest prevalence (36.2%) observed among 12-23 months. Children being stunted or normal in height was associated with prenatal services, maternal nutritional status, education, and duration of lactation. Maternal education (OR: 0.39; p=0.012), age-appropriate breastfeeding (OR: 0.63; p=0.042), and prenatal services like tetanus toxoid vaccination (OR: 0.67; p=0.011) and ultrasound (OR: 0.71; p=0.025) lowered the likelihood of a child being stunted. Conclusion: It is recommended to strengthen and intensify service delivery among pregnant and lactating women because of the implication of maternal factors to the length-for-age status of children 0-23 months.

Epidemiology of classic human astrovirus among infants and young children with acute diarrhea in a hospital outpatient in Shanghai, 2012-2016 / 中华传染病杂志

Objective:To investigate the epidemiological characteristics of classic human astrovirus (HAstV) among children under five years old with acute diarrhea, and to understand the role of HAstV in children acute diarrhea.Methods:A total of 1 010 fecal specimens were collected in 1 010 outpatients under five years old with acute diarrhea admitted to Children′s Hospital of Fudan University, Shanghai from January 2012 to December 2016. Reverse transcription polymerase chain reaction (PCR) or PCR was used for screening classic HAstV, group A rotavirus, norovirus and adenovirus. Genotypes of classic HAstV were determined by nucleotide sequencing and phylogenetic tree analysis.Results:The overall positive rate of classic HAstV was 2.7%(27/1 010). The detection rates of classic HAstV from 2012 to 2016 were 6.9%(10/144), 3.5%(5/144), 2.1%(3/144), 1.5%(4/265) and 1.6%(5/313), respectively. Almost 96.3%(26/27) of children infected with HAstV were 0 to 36 months of age. The prevalence of classic HAstV infections displayed a typical autumn/winter seasonality except in 2016. All the positive classic HAstV strains were genotyped as HAstV-1 with two lineages of HAstV-1a and HAstV-1b. Among them, the lineage of HAstV-1a was the predominant subtype (63.0%, 17/27). There were 77.8%(21/27) of the children with acute diarrhea only infected with classic HAstV, whereas for the remaining cases a variety of other enteric viruses were detected (three cases co-infected with HAstV and group A rotavirus, two cases co-infected with HAstV and adenovirus, and one case co-infected with HAstV, group A rotavirus and adenovirus).Conclusions:Children infected with HAstV are mainly less than 36 months of age. Although the genotype of classic HAstV detected in this study is single, but the lineages are in a state of dynamic change. Long-time and continuous monitor for the epidemiology of classic HAstV is needed to avoid outbreak of diarrhea in children.

Maternal characteristics and weight-for-length status of young children aged 0-23 months in the Philippines

@#<p style="text-align: justify;"><strong>Introduction.</strong> Malnutrition in the forms of wasting and overweight among children ages 0 to 23 months is a continuing public health concern in the Philippines. Childhood malnutrition has lifelong consequences. For young children aged 0-23 months, maternal influences play a significant role in the realization of optimal nutritional status.</p><p style="text-align: justify;"><strong>Objective.</strong> This study aimed to identify maternal characteristics that may influence the nutritional status of children aged 0-23 months.</p><p style="text-align: justify;"><strong>Methods.</strong> This study utilized data from the 2015 Updating Survey from Department of Science and Technology-Food and Nutrition Research Institute. The association of maternal characteristics with the nutritional status of a child was determined using the Rao-Scott Chi-squared test statistic. Multinomial logistic regression was used to model a child's nutritional status using weight-for-length as an indicator.</p><p style="text-align: justify;"><strong>Results.</strong> A child whose mother was educated was less likely to be wasted. The odds of a child being wasted was observed to increase with underweight mothers, longer duration of lactation and higher wealth quintile. Alternatively, the odds of a child to be overweight is reduced if the mother had formal education, was in late lactation stage, and availed tetanus toxoid vaccine. The likelihood that a child will be overweight increased with higher family wealth quintile and obesity of the mother.</p><p style="text-align: justify;"><strong>Conclusion.</strong> Maternal nutritional status, education, duration of lactation, wealth quintile, and availment of prenatal services were found to be associated with the weight-for-height status of children 0-23 months. Incorporating the identified maternal factors when planning new interventions and policies is recommended to address wasting in young children.</p>

Compliance with 14 day zinc therapy for acute diarrhoea: a prospective observational study

Background: Acute diarrheal diseases remain a leading cause of global morbidity and mortality in young children. The effective implementation of provision of zinc in addition to low osmolarity ORS remains very poor.Methods: A prospective observational study was done to determine compliance with zinc therapy on 103 children aged between two months to five years with acute gastroenteritis. They were started on WHO ORS and zinc in the form of syrup (20 mg/day in those >6 months of age and 10mg/day in those <6 months of age) and advised to continue for 14 days. Further episodes of diarrhea was considered as the primary outcome variable. Number of days zinc taken was considered as the primary explanatory variable. p-value <0.05 was considered statistically significant.Results: The mean age was 19.49'14.41 months. The compliance to complete 14-day zinc therapy was 62.14%.' The mean number of days zinc was taken was 11.28'3.81 days. In 11.65% of participants, there was further episodes of diarrhea. The main reasons for discontinuation were diarrhea stopped (45%), Ignorance (37.5%), URI (12.5%).Conclusions: Findings indicate that the syrup formulation is acceptable, but further efforts are required to enhance adherence. These findings also highlight the importance of guiding in ensuring adherence to zinc duration while also addressing the tendency of caregivers to terminate treatment once a child appears to have recovered from an acute diarrheal episode.

Performance and correlation of QuantiFERON-TB Gold, T-SPOT.TB and tuberculin skin test in young children with tuberculosis exposure or tuberculosis disease

To evaluate the performance of interferon gamma release assays and tuberculin skin test in Bacillus Calmette-Guerin vaccinated young children. Methods: A cross-sectional study was conducted in healthy children younger than 5 years who were recently diagnosed with tuberculosis or had recent exposure to active tuberculosis. QuantiFERON-TB Gold, T-SPOT.TB and tuberculin skin test were performed in each patient. Results: Of the 60 children, median age 3.3 years, 17 had tuberculosis and 43 had recent tuberculosis exposure. Overall, 15 (25.0%) children had tuberculin skin test reaction =10 mm; 8 (13.3%) were positive by QuantiFERON-TB Gold In-Tube test, and 12 (20.0%) by T-SPOT.TB. Nineteen (31.7%) children had at least one positive test. There was a moderate agreement between interferon gamma release assays and tuberculin skin test. Conclusions: The positive rates of interferon gamma release assays and tuberculin skin test were low in young children who were infected with tuberculosis, supporting the management strategy of not testing children younger than 5 years. (IGRA) do not react to BCG and most NTM[2], are preferred to TST in older children and adults[3], but may be less reactive in young children with immature T-cell function. Due to the limited knowledge of IGRA in BCG-vaccinated young children, we evaluated the performance and correlation of IGRA tests and TST in young children in a high TB burden setting who received BCG vaccination at birth and recently diagnosed with LTBI, or with active TB.

25-hydroxyvitamin D, bone source alkaline phosphatase and ultrasound bone density combined in detection of rickets in infants / 上海预防医学

Objective To analyze the application of serum 25-hydroxyvitamin D (25-OH-D), bone source alkaline phosphatase (BAP) and ultrasonic bone mineral density (BMD) in the detection of infantile rickets aged 3-12 months. Methods Six to 12 months old rickets infants and healthy ones were randomly selected from March to December 2018 in a hospital in Changning, who were divided into two groups as observation or control group (160 infants in each).Two groups were respectively tested with serum 25-OH-D, BAP activity and ultrasonic bone density, so as to explore the diagnostic efficacy of the three combined tests for infant rickets. Results The serum 25-OH-D level and the BMD in the observation group were significantly lower than that in the control group (P < 0.05), and the abnormal detection rate of BAP in the control group was significantly lower than that in the observation group (P < 0.05).There was no statistical significance (P>0.05) between the three detection methods, but the sensitivity and accuracy of the three detection methods combined were significantly better than that of any single detection method (P < 0.05). Conclusion The combined detection with serum 25-OH-D level, BAP activity and ultrasonic BMD can significantly improve the detection efficiency of rickets in infants aged 6-12 months, which is valuable and worthy of clinical application.

Performance and correlation of QuantiFERON-TB Gold, T-SPOT.TB and tuberculin skin test in young children with tuberculosis exposure or tuberculosis disease

To evaluate the performance of interferon gamma release assays and tuberculin skin test in Bacillus Calmette-Guerin vaccinated young children. Methods: A cross-sectional study was conducted in healthy children younger than 5 years who were recently diagnosed with tuberculosis or had recent exposure to active tuberculosis. QuantiFERON-TB Gold, T-SPOT.TB and tuberculin skin test were performed in each patient. Results: Of the 60 children, median age 3.3 years, 17 had tuberculosis and 43 had recent tuberculosis exposure. Overall, 15 (25.0%) children had tuberculin skin test reaction =10 mm; 8 (13.3%) were positive by QuantiFERON-TB Gold In-Tube test, and 12 (20.0%) by T-SPOT.TB. Nineteen (31.7%) children had at least one positive test. There was a moderate agreement between interferon gamma release assays and tuberculin skin test. Conclusions: The positive rates of interferon gamma release assays and tuberculin skin test were low in young children who were infected with tuberculosis, supporting the management strategy of not testing children younger than 5 years. (IGRA) do not react to BCG and most NTM[2], are preferred to TST in older children and adults[3], but may be less reactive in young children with immature T-cell function. Due to the limited knowledge of IGRA in BCG-vaccinated young children, we evaluated the performance and correlation of IGRA tests and TST in young children in a high TB burden setting who received BCG vaccination at birth and recently diagnosed with LTBI, or with active TB.

Young Children's Family Sex Education in Rural Areas of Sichuan Province and Its Influencing Factors / 中国医学科学院学报

To understand the family sex education for young children in rural areas of Sichuan province and analyze the influencing factors. A multi-stage random sampling method was used to select 2246 parents of kindergarten children from rural areas in Sichuan province for a questionnaire-based survey.The Chi-square test and Logistic regression model were used for data analysis. It was found 1132(52.33%)parents had implemented family sex education for young children and 1031(47.67%)had not.Young children having asked sex-related questions(=1.536,95%=1.257-1.878),parents thinking that early childhood sex education is necessary(=3.691,95%=2.029-6.717),and parents having the intention to know early childhood sex education(=1.700,95%=1.274-2.269),and kindergarten having implemented early childhood sex education(=3.316,95%=2.515-4.372)were promoting factors for parents to conduct early childhood sex education,whereas a total annual household income at the middle level(=0.664,95%=0.456-0.968)was a hindering factor for parents to conduct early childhood sex education. Parents of young children in rural areas of Sichuan province have poor awareness of sex education,and the proportion of parents who have never conducted sex education for children is high.The total annual income of the family,whether the children have asked about sex-related questions,parents' attitude towards early childhood sex education,and whether the kindergarten has conducted the early childhood sex education are important factors that influence the level of children's family sex education.

Relationship between adherence to WHO “24-Hour Movement Guidelines for the Early Years” and motor skills or cognitive function in preschool children: SUNRISE pilot study / 体力科学

This study examined the relationship between meeting the World Health Organization’s (WHO) 24-Hour Movement Guidelines for the Early Years and motor skills and cognitive function in preschool children. Participants were 4-year-old boys and girls in urban and rural areas (n=69). Physical activity was measured using a triaxial accelerometer (ActiGraph GT3X). Screen time and sleep duration were assessed via self-report by guardians. Meeting the 24-h movement guidelines was defined as: 10 to 13 h/night and nap of sleep, ≤1 h/day of sedentary screen time, and at least 180 min/day more than 1.5 METs. Motor skills were evaluated by the Ages & Stages Questionnaires, Third Edition (ASQ-3). Executive functions (shifting, visual-spatial working memory and inhibition) were evaluated by the Early Years Toolbox (Japanese translation). The prevalence of children meeting all three recommendations was 7.2% and 7.2% met none of the three recommendations. Children meeting physical activity recommendation had a better inhibition score compared to children meeting none of the recommendation (p=0.005). While, children not meeting the sleep recommendation had a better inhibition score compared to children meeting of the recommendation (p=0.042). In conclusion, meeting the physical activity or sleep recommendations were positively or negatively associated with the inhibition score. On the other hand, meeting none of the sedentary behaviour and the 3 recommendations was not associated with motor skills or cognitive function.

Evaluación cualitativa y cuantitativa de enseñanza aprendizaje combinado, sobre alimentación del menor de dos años / Qualitative and quantitative assessment of combined teaching learning process on feeding of children under two years of age

INTRODUCCIÓN: la cátedra de pediatría con apoyo del Instituto de Investigación en Salud y Desarrollo de la UMSA, ha elaborado un módulo de enseñanza teórico práctico para brindar conocimiento científico actualizado sobre alimentación y nutrición del menor de dos años. Durante la última gestión universitaria se ha incursionado en la enseñanza virtual para incrementar el tiempo de lectura, y contar con mayor espacio para las actividades prácticas. MÁTERIALES Y MÉTODOS: el objetivo de este artículo es identificar las fortalezas y debilidades del proceso de enseñanza y aprendizaje (PEA) combinado; usando metodología cuantitativa (pre y post-prueba) y cualitativa (grupo focal). Se contó con un total de 39 estudiantes. La prueba de conocimientos post intervención tuvo un puntaje de 771 mayor que la previa (p=0,000 ((IC 95% 642,35 - 901,23); y se respondió en menor tiempo (-219,43 segundos p=0.0000 (IC 95% (146,98 ­ 291,88). Un 81% de estudiantes estaba en el límite o por encima de lo que se consideró mínimo adecuado de facilidades informáticas. El grupo focal evidencio dificultades en el portal virtual, como muchos pasos para el ingreso, la saturación del servicio y otras; se dieron múltiples sugerencias para mejorar el módulo. RESULTADOS: este estudio demuestra que además de adquirir conocimientos, los estudiantes se han involucrado en los diferentes aspectos PEA; en base a sus sugerencias se ha comenzado a realizar cambios incluyendo la introducción de herramientas digitales de uso colaborativo como Wiki. CONCLUSIÓN: se concluye que el PEA combinado aplicado en la catedra de pediatría de la UMSA mejora la adquisición de conocimientos y prácticas sobre lactancia materna y alimentación complementaria del menor de dos años.

INTRODUCTION: the pediatric department with the support of the Institute of Research in Health and Development of the UMSA has developed a practical and theoretical teaching module to provide updated scientific knowledge on food and nutrition for children under two years of age. During the last university year, virtual teaching has been introduced to increase reading time, and to have more space for practical activities. MATERIAL AND METHODS: the objective of this article is to identify the strengths and weaknesses of the combined Learning Teaching Process using quantitative (pre and post-test) and qualitative methodology (focus group); 39 students participated in the study. In the post-intervention knowledge test obtained a score of 771 higher than the one prior to intervention (p = 0.000 ((95% CI 642.35 - 901.23), and spent shorter time in answers (-219.43 seconds p = 0.0000 (95% CI % (146.98 - 291.88). A total of 81% of students were in the limit or above what was considered adequate or minimum computer facilities. The focus group evidenced difficulties in the virtual portal, as many steps for the entrance, the saturation of the service and others, multiple suggestions were given to improve the module. RESULTS: this study shows that in addition to acquiring knowledge, students have been involved in the different aspects of the Teaching Learning Process (TLP). Based on their suggestions, changes such as the introduction of collaborative digital tools (Wiki) have been made. CONCLUSIONS: the article concludes indicating that the combined TLP applied in the pediatric department of the UMSA improves the students' acquisition of knowledge and practices on breastfeeding and complementary feeding of the child two years.

The interval function of the welcoming center for young children and their parents / A função de intervalo do espaço de acolhimento para pequenas crianças e seus pais

RESUMO: No presente artigo, questionamos a função exercida por um espaço de acolhimento para crianças de até três anos e seus pais. Após uma breve descrição desse dispositivo inspirado no modelo francês da Maison Verte, criada por Françoise Dolto, discutimos o funcionamento de diferentes instituições da primeira infância e interrogamos o papel do espaço de acolhimento. Defendemos, por fim, que ele ocupa uma função denominada de intervalo, pois permite a introdução de um espaço possível no laço entre pequenas crianças e seus pais, favorecendo, assim, a separação e a emergência do sujeito do desejo.

Abstract: In this paper, we question the role played by a welcoming center for children up to three years old and their parents. After a brief description of this device, which is inspired by the French model of the Maison Verte created by Françoise Dolto, we discuss the functioning of different institutions in early childhood and we question the welcoming center's role. We defend that it occupies a function called interval, since it allows the introduction of a possible space in the bond between young children and their parents and thus favors the separation and the emergence of the subject of desire.

Knowledge, attitude and practice of fever and febrile illness among parents of under five children

Background: Fever in children is the commonest cause for outpatient and inpatient admissions in the health care setup. Though most fever episodes are benign with self-limiting course, it is often a reason for anxiety and concerning for parents. The aim of the study was to assess the parental knowledge, attitude and practice regarding fever in children under five years of age.Methods: A cross-sectional question based survey, conducted in the pediatric department of a peripheral hospital in Pune, Maharashtra from parents of under five children, presenting for any consultation from July 2018 to December 2018.Results: There were 636 respondents who completed the study. 38.1% were males. Mean age of responders was 26.85 years (SD 5.12 Range 18 to 37 years). Most of the population were educated lot. 55.5% responders defined fever correctly. There was a huge gap in the parent's knowledge attitude and practice in fever and it's management. Lack of information and fear of any untoward incident occurring due to fever were the reason for parental anxiety, frequent medication & combination antipyretic use, and pressure on part of health professionals to increase antibiotic prescriptions.Conclusions: Lack of parental knowledge of fever and fever management in younger children is of concern in the community in spite of improvement in the educational level of parents. There is a utmost need to spread awareness in the community about the benign and the self-limiting nature of most febrile illnesses.

Health Risk Assessment of a Food Supplement Containing Lactobacillus reuteri Protectis®

The Norwegian Scientific Commitee for Food Safety (VKM) appointed a working group of experts to answer a request from the Norwegian Food Safety Authority regarding health risk assessment of Lactobacillus reuteri Protectis® in a food supplement intended for use by infants and young children. The mandate of this health risk assessment was not to evaluate the health claims related to the products as such health claims are assessed by EFSA. The specific strain DSM 17938 is a “daughter strain” of the strain ATCC 55730 which was originally isolated from normal human milk. ATCC 55730 harbours two plasmids carrying transferable resistance genes against tetracycline and lincosamides respectively. The “daughter strain” DSM 17938 was established in 2008 by curing the ATCC 55730 for these plasmids, but is in all other respects claimed to be identical to ATCC 55730 and bioequivalence of the two strains has been suggested. The strain DSM 17938 was still resistant to tetracycline (although at a considerably lower level than ATCC 55730) and a number of other antibiotics, but these resistances were all considered being intrinsic by FBO. The absence of possible transferable/mobile genes has, to our knowledge, not been confirmed in later studies. We are not aware of any data indicating that L. reuteri has been the cause of serious human diseases – and none of the studies examined has reported any adverse or undesirable short time effects. It has also been used in preterm infants with dosage corresponding to the actual recommended doses - without reporting any adverse, short term reaction. There is therefore no evidence leading to consider the strain DSM 17938 at the dosage recommended as unsafe. However, more long-term data are still lacking and the long-term safety for the age groups considered in this assessment cannot be established. As evidence is accruing that the early microbial composition of the infant gut is important for the development of the gut flora and the immune system of the growing child, it is not possible to exclude that a daily supply of a particular bacterial strain over a prolonged period of time to an immature gastro-intestinal tract may have long-term, albeit still unknown, adverse effects on it’s development. As the long-term data are lacking it is not possible to answer whether the amount of the food supplement or the age of the infant or young child is of importance. However, if later long-term data should reveal any adverse reaction, it is reasonable to assume that the actual age group will be the most vulnerable. As the safety was not entirely established, the question of whether there are any vulnerable groups (i.e. premature, infants or children with diseases) where there are health risks associated with the intake of Lactobacillus reuteri Protectis®, as a food supplement was not considered.