Developmental Feeding Stages and Their Impact on Child Feeding Behavior.

OBJECTIVES: Previous research has shown that critical periods of feeding skills development exist and feeding problems can arise in children due to delays in attaining feeding developmental milestones. This study aims to delineate the transitional process of feeding development in healthy children and children with gastrointestinal diseases (GIDs) and to examine the relationship between feeding milestones and the appearance of later feeding problems. METHODS: A cross-sectional case-control study among 711 healthy Greek children and 119 children with GID, aged 2-7 years. Parents completed the Greek version of the Behavioral Pediatrics Feeding Assessment Scale and "self-reported" questionnaires assessing child's feeding history. RESULTS: Differences in feeding behavior of preschoolers between the 2 groups were found concerning the time of introduction of complementary (pureed), lumpy, and table foods as well as finger feeding and regular cup-drinking. Age-specific milestones as proposed by guidelines were not reached. Late introduction of complementary and lumpy foods (>6 months and >9 months, respectively) as well as finger feeding (>9 months) were predictive of more problematic feeding behaviors later on. CONCLUSIONS: The trajectory of feeding development, including less studied feeding milestones, both in healthy children and children with GIDs, indicates that there are discrepancies between current feeding practices and infant feeding guidelines, and a tendency to delay the acquisition of all assessed feeding milestones.

Immunologic Response to SARS-CoV-2 Vaccination in Pediatric Kidney Transplant Recipients: A Systematic Review and Meta-Analysis.

The pediatric population is at a lower risk of severe SARS-CoV-2 infection compared to adults. Nevertheless, immunosuppression in pediatric and adolescent kidney transplant recipients (KTRs) increases their hazard compared to the general population. This systematic review evaluates the efficacy of SARS-CoV-2 vaccines and determines the risk factors of no seroconversion in this population. PubMed-MEDLINE databases were searched for cohort studies. A meta-analysis was performed using fixed and random effect models. In total, seven studies including 254 patients were further analyzed. The random effect model demonstrated a 63% seroconversion rate (95% CI 0.5, 0.76) following a two-dose schedule, which increased to 85% (95% CI 0.76, 0.93) after the third dose administration. Seropositivity was lower in patients under mycophenolate mofetil compared to azathioprine (OR 0.09, 95% CI 0.02, 0.43). Rituximab administration decreased the seroconversion rate (OR 0.12, 95% CI 0.03, 0.43). The glomerular filtration rate (GFR) was 9.25 mL/min/1.73 m2 lower (95% CI 16.37, 2.13) in patients with no seroconversion. The seroconversion rate was lower in vaccinated compared to infected patients (OR 0.13, 95% CI 0.02, 0.72). In conclusion, vaccination against SARS-CoV-2 in pediatric and adolescent KTRs elicits a humoral response, and a third dose is advised. Previous rituximab administration, antimetabolite therapy with mycophenolate mofetil and lower GFR reduce the likelihood for seroconversion.

Association of rs738409 Polymorphism in Adiponutrin Gene with Liver Steatosis and Atherosclerosis Risk Factors in Greek Children and Adolescents.

Non-alcoholic fatty liver disease (NAFLD) shares several risk factors with atherosclerosis, as it is associated with components of the metabolic syndrome. However, genetic variations have also been linked to the risk of NAFLD, such as adiponutrin/patatin-like phospholipase domain-containing the protein 3 (PNPLA3) rs738409 polymorphism. The aim of the study was to determine the associations of thePNPLA3 rs738409 polymorphism with NAFLD and atherosclerosis risk factors in children and adolescents from northern Greece. A total of 91 children/adolescents who followed a Mediterranean eating pattern with no particular restrictions were studied. They were divided into three subgroups, according to their body mass index (BMI) and the presence or absence of liver disease. Diagnosis of NAFLD was based on a liver ultrasound, while the distribution of the PNPLA3 rs738409 polymorphism was investigated in all the participants. From the components of metabolic syndrome, only BMI, waist circumference, blood pressure, and the homeostasis model of insulin resistance (HOMA-IR) differed significantly between groups. The rs738409 polymorphism was significantly associated with BMI and NAFLD, while lipid values had no significant association with either NAFLD or gene polymorphism. This study shows that in Greekchildren, there is a significant association between the rs738409polymorphism in the PNPLA3 gene and hepatic steatosis, regardless of bodyweight.

Factors Associated with Feeding Problems in Young Children with Gastrointestinal Diseases.

Feeding problems are associated with the consumption of a limited amount or restricted variety of foods and often occur in children with gastrointestinal diseases. The majority of studies to date do not use valid and reliable measurements to detect feeding problems. The aim of this cross-sectional study was to assess behavioral and skill-based feeding problems in young children with gastrointestinal diseases by using a well-established parent-reported feeding measure and identify demographic, anthropometric, and environmental factors associated with maladaptive feeding behaviors in this pediatric population. Parents completed the Greek version of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) and self-reported questionnaires assessing mealtime environment and parental feeding practices. It was found that 18.6% of the sample had abnormal Total Frequency Score (TFS) (frequency of problematic feeding behaviors) and 39.5% had abnormal Total Problem Score (TPS) (number of behaviors perceived as problematic by parents). Younger children, with lower body mass index, lower birth weight, and only children were more likely to have feeding problems. The study showed that parent-reported feeding problems are increased in young children with gastrointestinal diseases and are associated with specific aspects of mealtime environment and parental feeding practices.

Feeding Problems in Typically Developing Young Children, a Population-Based Study.

Feeding problems have been estimated to occur in approximately 25-45% of normally developing children. The aim of this study was to investigate the prevalence of feeding problems in typically developing young children in Greece. Child feeding behavior, parents' feelings about their child's feeding patterns, and parental feeding practices were also explored. Parents completed the Greek version of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS). Data on 742 healthy, typically developing children aged two to seven years are presented. Overall, the majority of children in the sample showed high frequency of desirable mealtime behaviors and low frequency of undesirable mealtime behaviors. However, a significant proportion of the cohort presented with food neophobia and low consumption of vegetables. When applying test cut-off scores, it was found that 8.2% of the sample had abnormal Total Frequency Score (TFS) and 26.6% had abnormal Total Problem Score (TPS). The study showed that parent-reported feeding problems are quite common in children of typical development in Greece. Moreover, while the majority of the sample displayed a high frequency of favorable behaviors, specific child feeding behaviors are amenable to improvement.

Mealtime Environment and Control of Food Intake in Healthy Children and in Children with Gastrointestinal Diseases.

Parental feeding practices and mealtime routine significantly influence a child's eating behavior. The aim of this study was to investigate the mealtime environment in healthy children and children with gastrointestinal diseases. We conducted a cross-sectional case-control study among 787 healthy, typically developing children and 141 children with gastrointestinal diseases, aged two to seven years. Parents were asked to provide data on demographics and describe their mealtime environment by answering to 24 closed-ended questions. It was found that the majority of the children had the same number of meals every day and at the same hour. Parents of both groups exerted considerable control on the child's food intake by deciding both when and what their child eats. Almost one third of the parents also decided how much their child eats. The two groups differed significantly in nine of the 24 questions. The study showed that both groups provided structured and consistent mealtime environments. However, a significant proportion of children did not control how much they eat which might impede their ability to self-regulate eating. The presence of a gastrointestinal disease was found to be associated with reduced child autonomy, hampered hunger cues and frequent use of distractions during meals.

Children with diseases of the upper gastrointestinal tract are more likely to develop feeding problems.

Feeding problems may give rise to a number of adverse effects with organic, psychological, developmental and social impact. Specific medical conditions, especially diseases of the gastrointestinal system, are known to be associated with feeding problems. We searched databases, including MEDLINE and the Cochrane Library, for papers published in English from 1990 to March 2018. Keywords included "gastrointestinal diseases", "gastroesophageal reflux disease", "eosinophilic esophagitis", "food allergy", "children", "infants", and "feeding problems". We concluded that children with diseases of the upper gastrointestinal tract, especially those with gastroesophageal reflux disease and eosinophilic esophagitis, are more likely to develop feeding problems. However, further epidemiological studies are needed to determine the prevalence and the specific characteristics of feeding problems in children with certain upper gastrointestinal diseases, as well as the exact causal relationship between them.