Child feeding and care behaviors are associated with xerophthalmia in rural Nepalese households.

The study examined caregiver-child interactions, intrahousehold food allocation and general child care behaviors and their effect on children's xerophthalmia status in the rural Terai region of Nepal. Seventy-eight households with a child having a history of xerophthalmia (cases) were matched with 78 households with a child of the same age having no history of xerophthalmia (controls). Seven day-long continuous monitoring observations were performed in each household (over 15 months) by trained Nepali observers, focusing on feeding and care of a focus child and his/her younger sibling. Nineteen different behavioral variables were operationalized, including serving method, second helpings, serving refusals, encouragement to eat, request intensity, meal serving order, food channeling, food sharing, positive social behaviors, negative social behaviors, and positive health behaviors. Automatic serving and request intensity were strongly negatively correlated, especially among younger siblings. Children who serve themselves receive less encouragement to eat. Those children who are refused in their requests for food tend to ask for food more frequently, for a longer time, and be less likely to self-serve. Children who eat from a shared plate are less likely to interact with a food server and more likely to self-serve. Negative social behavior towards children is associated with the child having to request food more frequently and a greater likelihood of being refused food. Children who receive positive health care from their caregivers are also more frequently asked if they would like food by the server and are encouraged to eat. Several caregiver child feeding behaviors were related to a child's risk of having past vitamin A deficiency. Controls were much more likely to be served food automatically. Cases were more likely to serve themselves food and have multiple servings of food. Cases were nearly two times more likely than controls to be treated with neglect or harshly, and much less likely than controls to have their health needs receive attention. Examining intrahousehold behavior is critical for understanding the causes of vitamin A deficiency in rural Nepalese children, and has great potential for identifying and improving interventions to improve children's diets and care.

Eating from a shared plate affects food consumption in vitamin A-deficient Nepali children.

This case-control study evaluates the relationship between shared-plate eating behavior in young Nepali children (aged 1-6 y) and risk of vitamin A deficiency. Day-long observations of dietary practices were conducted on 7 d over a 15-mo period in 162 households: 81 households with a child with a known history of mild xerophthalmia (cases) were matched with 81 having a non-xerophthalmic child of similar age (controls). Shared-plate eating occurred in 25% of all feeding episodes and at least once in 65% of all days observed. Overall, children engaging in shared-plate eating were significantly more likely to consume grains, vegetables, carotenoid-rich vegetables, pulses, fruits, meats and fish, and dairy products and had significantly larger portion sizes for grains, vegetables, fruits, pulses and dairy products, compared with children who ate alone. In general, feeding behaviors between case and control children tended to be similar. However, shared-plate feeding episodes among case children were significantly less likely to include meats or fish [odds ratio (OR) = 0.5, confidence interval (CI) = 0.3-0.8], dairy products (OR = 0.6, CI = 0.4-0.9) or pulses (OR = 0.7, CI = 0.5-1.0). Individual-plate feeding episodes among case children were more likely to include vegetables (OR = 1.3, CI = 1.0-1.6) than those of control children. Case children were more likely to share a plate with a male adult (OR = 1.7, CI = 1.0-2.8), but less likely to eat from a plate shared with females of any age compared with controls (female adult: OR = 0.6, CI = 0.4-0.9; female child: OR = 0.6, CI = 0.4-1.0). Shared-plate eating may benefit a young child's dietary intake, but the identity of the food sharer may modify this influence.

Neuroanatomy of Rett syndrome: a volumetric imaging study.

Rett syndrome is a pediatric neurological disorder of unknown etiology defined by the presence of severe neurodevelopment decline, acquired microcephaly, dementia, abnormalities of movement, autistic behavior, and seizures in young female children. In this study, the neuroanatomy of 11 females with Rett syndrome and 15 age- and gender-matched control subjects was investigated in vivo with quantitative neuroimaging techniques. Compared to control subjects, the patients with Rett syndrome were found to have significantly reduced cerebral volume; evidence of greater loss of gray matter in comparison to white matter; regional variation in cortical gray matter, with the frontal regions showing the largest decrease; and reduced volume of the caudate nucleus and midbrain, even when taking into account general reduction in the size of the brain. In addition, there was no evidence of an ongoing degenerative process in this sample of girls with Rett syndrome. The consistency of these data with results from neuropathological investigations points to the need for continued quantitative neuroimaging studies of children with this condition. In particular, research employing serial longitudinal scans of very young children manifesting early signs of the clinical syndrome holds promise for helping to elucidate the neuropathological pathways leading to the debilitating clinical manifestations of Rett syndrome.