Impact of maternal depressive symptoms on offspring executive functions: a systematic review.

OBJECTIVE: This systematic review aims to thoroughly examine the current understanding of the effect of maternal depression exposure on the executive functions of offspring. METHODS: Following the PRISMA statement, a comprehensive search for peer-reviewed cohort studies was performed on Pubmed, ScienceDirect, LILACS, PsychINFO, and SciELO. Study quality was assessed using the NIH National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-sectional studies. The evidence was evaluated using the Grading of Recommendation, Assessment, Development, and Evaluation. RESULTS: This review analyzed 33 cohort studies from different countries with a total of 38,981 participants. Twenty-four studies confirmed the hypothesis of the harmful effect of maternal depressive symptoms on the performance of children's executive functions. However, a high heterogeneity among studies was found, and meta-analysis was not feasible. Fetal programming, genetics, and parental practices have been identified as potential mechanisms that can affect the executive functions of children born to mothers who have experienced depressive symptoms. CONCLUSIONS: The results suggest a negative association between maternal depressive symptoms and offspring executive functioning. Further studies on the effects of chronicity/severity of maternal symptoms and changes in executive functions in different sensitive periods are needed.

Prevalence of adolescent risk behaviors at 11 and 15 years of age: data from the 2004 Pelotas birth cohort

Objectives: The objective of this study was to investigate the prevalence of the following risk behaviors: experimentation with cigarettes, electronic cigarettes, alcohol, substances, delinquent behavior, and sex at age 15, stratified by sex and socioeconomic position. We also investigated the prevalence of cigarette and alcohol experimentation at age 11 and the persistence and cumulative incidence of these behaviors between 11 and 15 years of age. Methods: In this cohort study, we included 3,491 11-year-olds and 1,949 15-year-olds from the 2004 Pelotas Birth Cohort. All outcomes were identified via confidential questionnaires and were analyzed as binary variables. Results: At age 11, there was a higher prevalence of cigarette experimentation among boys. At age 15, there was a higher prevalence of experimentation with alcohol, cigarettes, and substances among girls; experimentation with cigarettes and sex were more prevalent among those in a low socioeconomic position. We found a high cumulative incidence of alcohol experimentation, as well as persistent alcohol experimentation, in both boys and girls. Conclusions: Further research should clarify causal paths of the high prevalence of risk behaviors during adolescence and its increase among girls.

Prevalence of adolescent risk behaviors at 11 and 15 years of age: data from the 2004 Pelotas birth cohort.

OBJECTIVES: The objective of this study was to investigate the prevalence of the following risk behaviors: experimentation with cigarettes, electronic cigarettes, alcohol, substances, delinquent behavior, and sex at age 15, stratified by sex and socioeconomic position. We also investigated the prevalence of cigarette and alcohol experimentation at age 11 and the persistence and cumulative incidence of these behaviors between 11 and 15 years of age. METHODS: In this cohort study, we included 3,491 11-year-olds and 1,949 15-year-olds from the 2004 Pelotas Birth Cohort. All outcomes were identified via confidential questionnaires and were analyzed as binary variables. RESULTS: At age 11, there was a higher prevalence of cigarette experimentation among boys. At age 15, there was a higher prevalence of experimentation with alcohol, cigarettes, and substances among girls; experimentation with cigarettes and sex were more prevalent among those in a low socioeconomic position. We found a high cumulative incidence of alcohol experimentation, as well as persistent alcohol experimentation, in both boys and girls. CONCLUSION: Further research should clarify causal paths of the high prevalence of risk behaviors during adolescence and its increase among girls.

Trajectories of maternal depressive symptoms and offspring's risk behavior in early adolescence: data from the 2004 Pelotas birth cohort study.

BACKGROUND: This longitudinal study explored the relationship between trajectories of maternal depressive symptoms and offspring's risk behavior in adolescence contributing to an extremely scarce literature about the impacts of maternal depression trajectories on offspring risk behaviors. METHODS: We included 3437 11-year-old adolescents from the 2004 Pelotas Birth Cohort Study. Trajectories of maternal depressive symptoms were constructed using Edinburgh Postnatal Depression Scale (EDPS) from age 3 months to 11 years. We identified five trajectories of maternal depressive symptoms: "low" "moderate low", "increasing", "decreasing", and "chronic high". The following adolescent outcomes were identified via self-report questionnaire and analyzed as binary outcome -yes/no: involvement in fights and alcohol use at age 11. We used logistic regression models to examine the effects of trajectories of maternal depressive symptoms on offspring's risk behavior adjusting for potential confounding variable. RESULTS: Alcohol use and/or abuse as well as involvement in fights during adolescence, were not significantly associated with any specific trajectory of maternal depressive symptoms neither in the crude nor in the adjusted analyses. CONCLUSION: Alcohol use and involvement in fights at age 11 were not associated with any specific trajectory of maternal depression.

Factors associated with risk behaviors in adolescence: a systematic review.

OBJECTIVE: Understanding the distal (≤ 6 years of age) and proximal (between 6 years of age and early adolescence) factors in adolescent risk behavior is important for preventing and reducing morbidity and mortality in this population. This study sought to investigate the factors associated with the following adolescent risk behaviors: i) aggressiveness and violence, ii) tobacco, alcohol, and illicit substance use, iii) depressive behavior and self-harm (including suicidal ideation and attempts), iv) sexual risk behavior, and v) multiple risk behavior. METHODS: A systematic review was conducted to identify longitudinal studies that examined factors associated with adolescent risk behaviors. The PubMed, PsycINFO, and LILACS databases were searched. RESULTS: Of the 249 included studies, 23% reported distal risk factors, while the remaining reported proximal risk factors. Risk factors were related to sociodemographic characteristics (neighborhood, school, and peers), family patterns, and the presence of other adolescent risk behaviors. CONCLUSION: Distal and proximal factors in adolescent risk behavior that are not exclusively socioeconomic, familial, environmental, or social should be explored more thoroughly.

Decreased health-related quality of life in children and adolescents with autoimmune hepatitis / Redução na qualidade de vida relacionada à saúde em crianças e adolescentes com hepatite autoimune

Abstract Objective: The objective of this study was to evaluate the health-related quality of life in children and adolescents with autoimmune hepatitis. Methods: A cross-sectional assessment with the Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) was completed for 80 patients with autoimmune hepatitis and 45 healthy controls. Demographic data, prednisone dose, disease remission state, disease severity, and abdominal pain were also evaluated. Results: Based on the child self-reports, physical, emotional, school, and total scores were significantly lower in autoimmune hepatitis patients when compared with controls (p < 0.05). Based on the parental reports, only the physical and total scores were significantly lower in autoimmune hepatitis patients versus controls (p < 0.05). Further analysis in autoimmune hepatitis patients with abdominal pain in the last month revealed significantly lower physical, social, and total median scores (p < 0.05). No differences were observed based on disease remission state or disease severity (p > 0.05). Autoimmune hepatitis patients who received a prednisone dose below 0.16 mg/kg/day at the time of the interview showed significantly higher physical scores than those who received a dose similar to or above 0.16 mg/kg/day (87.5 [50-100] vs. 75 [15.63-100], p = 0.006). Conclusions: Reduced scores in the physical, emotional, and school domains were observed in pediatric autoimmune hepatitis patients compared to control patients. Abdominal pain and corticosteroid dose negatively influenced the health-related quality of life in children and adolescents with autoimmune hepatitis.

Resumo Objetivo: Avaliar a qualidade de vida relacionada à saúde em crianças e adolescentes com hepatite autoimune (HAI). Métodos: Foi concluída uma avaliação transversal com o Inventário Pediátrico de Qualidade de Vida 4.0 (PedsQL 4.0) para 80 pacientes com hepatite autoimune e 45 controles saudáveis. Os dados demográficos, a dose de prednisona, o estado de remissão da doença, a gravidade da doença e dor abdominal também foram avaliados. Resultados: Com base nos autorrelatos das crianças, os escores físico, emocional, escolar e total foram significativamente menores em pacientes com hepatite autoimune em comparação com os controles (p < 0,05). Com base nos relatos dos pais, apenas os escores físico e total foram significativamente menores em pacientes com hepatite autoimune em comparação com os controles (p < 0,05). Uma análise adicional em pacientes com hepatite autoimune com dor abdominal no mês passado revelou escores médios físico, social e total significativamente menores (p < 0,05). Nenhuma diferença foi observada com base no estado de remissão da doença ou na gravidade da doença (p > 0,05). Os pacientes com hepatite autoimune que receberam uma dose de prednisona abaixo de 0,16 mg/kg/dia no momento da entrevista mostraram escores físicos significativamente maiores que os que receberam uma dose semelhante ou acima de 0,16 mg/kg/dia [87,5 (50-100) em comparação com 75 (15,63-100), p = 0,006]. Conclusões: Escores reduzidos nos domínios físico, emocional e escolar foram observados em pacientes pediátricos com hepatite autoimune em comparação com pacientes do grupo de controle. Dor abdominal e dose de corticosteroide influenciaram negativamente a qualidade de vida relacionada à saúde em crianças e adolescentes com hepatite autoimune.

Dyslipidemia in children with feeding difficulties - a cross-sectional study in a Brazilian reference center / Dislipidemia en niños con dificultades alimentares - estudio transversal en un centro de referencia brasileño

ABSTRACT This study aimed at describing the lipid profile of children with feeding difficulties (FD), as well as to verify the impact of clinical types of FD and other markers on the presence of dyslipidemias (DLP). It was a cross-sectional study with 61 children between 2 and 10 years old. The following data was collected from medical records: age, gender, duration of exclusive breastfeeding (months), dosages of total cholesterol, HDL, LDL, VLDL and triglycerides (according to recommendations for age), type of FD, BMI z-score, dietary intake of carbohydrates and lipids (% energy intake), and daily consumption of milk (ml), fiber (g) and sugar sweetened beverages (SSB, ml). T-Student-test and ANOVA test were used, with a 5% significance level. Children were mostly picky eaters (55.7%), and 47.5% had dyslipidemia, mostly low HDL-c (27.6%) and hypertriglyceridemia (21.9%). No significant relationship was found between DLP and duration of exclusive breastfeeding (p= 0.93), BMI (p> 0.40), type of FD (p> 0.26), or dietary characteristics (p> 0.12). Children with dyslipidemia tended to drink higher volumes of SSB when compared to recommended values (p= 0.044). The prevalence of DLP found was higher than the average shown in children. More studies are needed to prove if there is a true association between FD and dyslipidemia.

RESUMEN El objetivo de este estudio fue describir el perfil lipídico de niños con dificultades alimentares (DA) y verificar el impacto de los tipos clínicos de DA y otros marcadores sobre la presencia de dislipemias (DLP). Se trató de un estudio transversal con 61 niños de 2 a 10 años. Se obtuvieron los datos de edad, sexo, duración de la lactancia materna exclusiva (meses), colesterol total, HDL, LDL, VLDL y triglicéridos (según las recomendaciones para la edad), tipo de DA, índice-z del IMC, consumo dietético de carbohidratos y lípidos (% energético), consumo diario de leche (ml), fibra (g) y bebidas endulzadas (SSB, ml). Se usaron pruebas T-Student y ANOVA, con nivel de significancia del 5%. Los niños fueron selectivos (55,7%) y el 47,5% dislipidémicos, principalmente con HDL-c bajo (27,6%) y hipertrigliceridemia (21,9%). No se encontró relación significante entre DLP y la duración de la lactancia materna exclusiva (p= 0,93), el IMC (p> 0,40), el tipo de DA (p> 0,26) o las características dietéticas (p> 0,12). Los niños dislipidémicos tendieron a beber mayores volúmenes de SSB en comparación con los valores recomendados (p= 0,044). La prevalencia de DLP encontrada es más alta que el promedio que se muestra en niños. Se necesitan más estudios para demostrar asociaciones sólidas entre DA y dislipidemia.

O pediatra deve investigar sintomas de transtornos obsessivos compulsivos em crianças com dificuldades alimentares? / Should pediatricians investigate the symptoms of obsessive-compulsive disorder in children with feeding difficulties?

RESUMO Objetivo: Revisar evidências atuais da relação entre transtorno obsessivo compulsivo e dificuldades alimentares. Métodos: Revisão das bases Science Direct e PubMed no período entre 2007 e 2017 em inglês, português e espanhol, com os termos em associação "transtorno obsessivo compulsivo" e "picky eating/dificuldade alimentar". Foram selecionados apenas estudos de coorte, caso controle ou transversal, realizados em qualquer país, com crianças, adolescentes e/ou adultos e de qualquer tamanho amostral. Foram excluídos os artigos de opinião. Resultados: Cerca de 245 artigos foram selecionados e apenas 4 foram incluídos no estudo, segundo critérios de seleção. Os trabalhos descrevem essencialmente que há diferença no comportamento seletivo entre os sujeitos com e sem transtorno obsessivo compulsivo, com tendência para exacerbação de sintomas como nojo, ansiedade e escore de inflexibilidade de comportamento alimentar nos pacientes com esse transtorno. Conclusões: Existem sintomas compartilhados entre transtorno obsessivo compulsivo e dificuldade alimentar. O estudo alerta aos profissionais que acompanham pacientes com dificuldades alimentares para a importância da investigação de possíveis comorbidades psiquiátricas.

ABSTRACT Objective: To review current evidence on the relationship between obsessive-compulsive disorder and feeding difficulties. Methods: Review the Science Direct and PubMed databases between 2007 and 2017 in English, Portuguese and Spanish. The search terms, used in association, were "obsessive compulsive disorder" and "picky eating/feeding difficulty". Cohort, case control and cross sectional studies were included that analyzed children, adolescents and/or adults of any sample size from any country in the world. Opinion articles were excluded. Results: Around 245 articles were selected, and only 4 were included in this review, according to previous criteria. Results from the studies essentially described that there is indeed a difference in "picky" behaviors between subjects with and without obsessive-compulsive disorder. Patients with obsessive-compulsive disorder tend to have exacerbated symptoms of disgust, anxiety and a higher eating behavior inflexibility score. Conclusions: Obsessive-compulsive disorder and feeding difficulties patients share common symptoms. The present study alerts health professionals who follow patients with feeding difficulties as to the importance of investigating possible psychiatric comorbidities.

Decreased health-related quality of life in children and adolescents with autoimmune hepatitis.

OBJECTIVE: The objective of this study was to evaluate the health-related quality of life in children and adolescents with autoimmune hepatitis. METHODS: A cross-sectional assessment with the Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) was completed for 80 patients with autoimmune hepatitis and 45 healthy controls. Demographic data, prednisone dose, disease remission state, disease severity, and abdominal pain were also evaluated. RESULTS: Based on the child self-reports, physical, emotional, school, and total scores were significantly lower in autoimmune hepatitis patients when compared with controls (p<0.05). Based on the parental reports, only the physical and total scores were significantly lower in autoimmune hepatitis patients versus controls (p<0.05). Further analysis in autoimmune hepatitis patients with abdominal pain in the last month revealed significantly lower physical, social, and total median scores (p<0.05). No differences were observed based on disease remission state or disease severity (p>0.05). Autoimmune hepatitis patients who received a prednisone dose below 0.16mg/kg/day at the time of the interview showed significantly higher physical scores than those who received a dose similar to or above 0.16mg/kg/day (87.5 [50-100] vs. 75 [15.63-100], p=0.006). CONCLUSIONS: Reduced scores in the physical, emotional, and school domains were observed in pediatric autoimmune hepatitis patients compared to control patients. Abdominal pain and corticosteroid dose negatively influenced the health-related quality of life in children and adolescents with autoimmune hepatitis.

SHOULD PEDIATRICIANS INVESTIGATE THE SYMPTOMS OF OBSESSIVE-COMPULSIVE DISORDER IN CHILDREN WITH FEEDING DIFFICULTIES? / O PEDIATRA DEVE INVESTIGAR SINTOMAS DE TRANSTORNOS OBSESSIVOS COMPULSIVOS EM CRIANÇAS COM DIFICULDADES ALIMENTARES?

OBJECTIVE: To review current evidence on the relationship between obsessive-compulsive disorder and feeding difficulties. METHODS: Review the Science Direct and PubMed databases between 2007 and 2017 in English, Portuguese and Spanish. The search terms, used in association, were "obsessive compulsive disorder" and "picky eating/feeding difficulty". Cohort, case control and cross sectional studies were included that analyzed children, adolescents and/or adults of any sample size from any country in the world. Opinion articles were excluded. RESULTS: Around 245 articles were selected, and only 4 were included in this review, according to previous criteria. Results from the studies essentially described that there is indeed a difference in "picky" behaviors between subjects with and without obsessive-compulsive disorder. Patients with obsessive-compulsive disorder tend to have exacerbated symptoms of disgust, anxiety and a higher eating behavior inflexibility score. CONCLUSIONS: Obsessive-compulsive disorder and feeding difficulties patients share common symptoms. The present study alerts health professionals who follow patients with feeding difficulties as to the importance of investigating possible psychiatric comorbidities.

OBJETIVO: Revisar evidências atuais da relação entre transtorno obsessivo compulsivo e dificuldades alimentares. MÉTODOS: Revisão das bases Science Direct e PubMed no período entre 2007 e 2017 em inglês, português e espanhol, com os termos em associação "transtorno obsessivo compulsivo" e "picky eating/dificuldade alimentar". Foram selecionados apenas estudos de coorte, caso controle ou transversal, realizados em qualquer país, com crianças, adolescentes e/ou adultos e de qualquer tamanho amostral. Foram excluídos os artigos de opinião. RESULTADOS: Cerca de 245 artigos foram selecionados e apenas 4 foram incluídos no estudo, segundo critérios de seleção. Os trabalhos descrevem essencialmente que há diferença no comportamento seletivo entre os sujeitos com e sem transtorno obsessivo compulsivo, com tendência para exacerbação de sintomas como nojo, ansiedade e escore de inflexibilidade de comportamento alimentar nos pacientes com esse transtorno. CONCLUSÕES: Existem sintomas compartilhados entre transtorno obsessivo compulsivo e dificuldade alimentar. O estudo alerta aos profissionais que acompanham pacientes com dificuldades alimentares para a importância da investigação de possíveis comorbidades psiquiátricas.

Clinical use of a food inventory to identify mayernal underreport on children's food intake: experience of a reference center in Brazil / Uso clínico do inventário alimentar para identificação do sub relato materno sobre ingestão alimentar em crianças: experiência de centro de referência brasileiro

Background: Feeding Difficulties (FD) are a common problem in childhood, and dietary assessments are extremely important to evaluate food consumption and selectivity patterns. In clinical practice, it is often observed that caregivers have an exacerbated perception of the severity of their children's FD and this may impact on dietary reports. Objectives: To compare the variety of foods consumed by children with FD under maternal perception to the evaluation performed by nutritionist using a food inventory in association with traditional methods. Methods: It is a cross sectional study with 119 motherchildren pairs, with complaints of FD followed at an outpatient service in São Paulo, Brazil. Data collected consisted of demographics, maternal caregiving style, responsibility over feeding the child, perception of children's feeding diversity (expressed in numbers, taken from a self-explanatory food inventory), presence of organic disease, type of FD, BMI Zscore, and actual repertoire of foods consumed (expressed in numbers, assessed by the nutritionist after evaluating the food inventory). The inventory provided information about the food items the child accepts without rejection, used to accept but now rejects, and completely rejects. Spearman correlation and Lynn's coefficient of variation, ANOVA and T-student tests were used, with a 5% significance level. Results and discussion: Overall food diversity ranged from 16 (p25%) to 30 (p75%) different types of foods. Maternal perceived food diversity ranged from 4,3 to 14,5 (p25-75). Around 23,7% of children were considered highly selective (less than 15 types of foods) (p=0,000). Maternal perception underestimated that assessed by the nutritionist in 2,2 times, with low reproducibility between these two variables (r=0,14). Both maternal perception and professional assessment did not vary according to age, organic comorbidities, gender, maternal parity, feeding style or responsibility over feeding routines (p>0,49). Findings enhance the importance of parental behavioral interventions and of the use of dietary research methodologies which are complementary to already validated strategies. Conclusions: There was maternal underestimation on the quantity of foods accepted by children with FD. The data reinforce the need for family orientation about the expectations regarding the feeding practices and preferences of their children

Introdução: As dificuldades alimentares (DA) são um problema comum na infância, e a avaliação dietética é extremamente importante para avaliar o consumo de alimentos e os padrões de seletividade. Na prática clínica, muitas vezes observa- se que os cuidadores têm percepção exacerbada da gravidade da DA de seus filhos, e isso pode afetar os relatos alimentares. Objetivos: comparar a variedade de alimentos consumidos por crianças com DA sob percepção materna à avaliação realizada por nutricionista, usando um inventário de alimentos em associação com métodos tradicionais. Métodos: Estudo transversal com 119 pares de mãe-filho, com queixas de DA atendidos em ambulatório em São Paulo, Brasil. Coletou-se dados demográficos, estilo parental materno, responsabilidade sobre a alimentação da criança, percepção da diversidade de alimentação das crianças (expressa em números, extraída de inventário de alimentos auto-preenchido), presença de doença orgânica, tipo de DA, IMC escorez, e repertório real de alimentos consumidos (expresso em números, avaliado pelo nutricionista depois de avaliar o inventário de alimentos). O inventário forneceu informações sobre alimentos que a criança aceita sem rejeição, costumava aceitar, mas agora rejeita, e rejeita completamente. Utilizouse correlação de Spearman e coeficiente de variação de Lynn, ANOVA e Teste T-student, com nível de significância de 5%. Resultados e discussão: a diversidade geral de alimentos variou de 16 (p25%) a 30 (p75%) tipos de alimentos. A percepção materna variou de 4,3 a 14,5 (p25-75). Cerca de 23,7% das crianças foram consideradas altamente seletivas (menos de 15 tipos de alimentos) (p = 0,000). A percepção materna subestimou a avaliação do nutricionista em 2,2 vezes, com baixa reprodutibilidade entre as duas variáveis (r = 0,14). Tanto a percepção materna como a avaliação profissional não variaram de acordo com a idade, comorbidades orgânicas, gênero, paridade materna, estilo parental ou responsabilidade sobre as rotinas de alimentação (p> 0,49). Os achados reforçam a importância das intervenções comportamentais com os pais e do uso de metodologias de investigação dietética complementares às estratégias já validadas. Conclusões: houve subestimação materna sobre a quantidade de alimentos aceitos por crianças com DA. Os dados reforçam a necessidade de orientação familiar sobre as expectativas quanto às práticas de alimentação e preferências de seus filhos

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Feeding difficulties are not associated with higher rates of iron deficiency anemia in Brazilian children and adolescents: cross-sectional study

Background: Iron deficiency anemia and feeding difficulties (FD) are common issues in childhood, reinforcing the concern about the risk of micronutrient deficiencies. FD do not necessarily reflect nutritional deficiencies, since they may or may not relate to specific nutrient sources. The objective of the study is to describe the prevalence of iron depletion and iron deficiency anemia in children with FD and to seek associations with diagnosis and its markers. Methods: This is a cross-sectional study with 68 patients (convenience sample). The following data were assessed through medical records: age (months), gender, exclusive breastfeeding duration (months), birth weight (kg), iron supplementation, hemoglobin (Hb), ferritin, and C-reactive protein (CRP) levels, repertory of foods consumed (food inventory and 3-day food record analysis), and diagnosis of FD. Data were classified according to references for age and were analyzed using correlation tests, Student's t test, ANOVA and chi-square test, or its nonparametric equivalents. A significance level of 5% was considered. Results: Iron depletion and anemia were identified in 10.1 and 6% of children, respectively. Picky eating was diagnosed in 35.3%. Food repertory consisted on average of 21 foods, with null correlation to Hb and ferritin. The average fortified milk intake was 517 ml/day, with null correlation to Hb. There was no effect of diagnosis of FD on Hb (p = 0.18) or ferritin (p = 0.52). The same was verified in the children without supplementation, to both Hb (p = 0. 54) and ferritin (p = 0.08). Conclusions: No evidence of association between diagnosis of FD or repertory of foods to anemia or iron depletion was found, which could be a reassuring factor for caregivers. Reproduction in large scale as well as inclusion of dietary intake variables is suggested for further research.

Delayed Development of Feeding Skills in Children with Feeding Difficulties-Cross-sectional Study in a Brazilian Reference Center.

BACKGROUND: Delays in gross motor development, sensory processing issues, and organic and behavioral problems are known to interfere in the development of feeding skills (FS); and-therefore-in the success of the process of feeding a child. Children with feeding difficulties (FD) commonly present inadequacy of FS. OBJECTIVES: Assessment of five FS in Brazilian children with FD, and search of associations with types of FD. METHODS: Cross-sectional study with 70 children below 10 years old. Data were obtained from medical records: age, gender, age at texture transitions, feeding phase (breastfeeding, weaning to solids or full solids) at first complaint; characteristics of the meal (duration, environment, and shared meals with adults), self-feeding practices, use of feeding equipment and bottle, mouthing, feeding position and FD diagnosis. Skills were categorized according to standards for age. Chi-Square, Anova Test (or non-parametric equivalent) and Multinomial logistic regression tests were used, with a significance level of 5%. RESULTS: There was no difference in FS (p > 0.05) or in the number of FS inadequateness (p = 0.84) according to FD diagnosis. The majority (94%) of children presented at least one delayed development of FS; 1/3 presented delays in more than half of the FS. The most prevalent inadequacies in FS were inadequate feeding position (73.5%), prolonged bottle feeding (56.9%), and inadequate self-feeding practices (37.9%). Feeding complaints first appeared at 10.9 ± 11.4 months, and picky eating was the most prevalent type of FD (37.1%). Most children were fed in inadequate environments (55.2%), without the company of adults (78%). Transition to solid foods occurred at 16 ± 5.6 months. Multinomial logistic regression showed no difference in likelihood of presenting any type of FD compared to picky eating, according to FS. Age at texture transition both from breastfeeding to complementary feeding (p = 0.95), and from complementary feeding to solid foods (p = 0.43) did not vary according to FD diagnosis. CONCLUSION: FS development or number of FS inadequateness did not vary according to FD diagnosis. Identification of these inadequacies could help the discussion for multi-professional treatment of patients with FD.

Does family mealtime have a protective effect on obesity and good eating habits in young people? A 2000-2016 review / Fazer refeições em família tem efeito protetor para a obesidade e bons hábitos alimentares na juventude? Revisão de 2000 a 2016

Abstract Objectives: to review the prevalence of family meals and its impact on BMI and eating habits during childhood and adolescence. Methods: reviews are from Bireme / Lilacs / Scielo / Cochrane and Pubmed, between 2000-2016 with descriptors "family meal or mealtime", "behavior", "nutrition or diet or consumption or eating", and "child or children or adolescence"; performed by two independent examiners, according to the systematic steps in English and Portuguese. The articles were selected based on prevalence and/ or discussion between nutritional variables. 2,319 articles were found, which 15 were selected all in English: systematic reviews (n=2), cross-sectional studies (n=8), longitudinal studies (n=8); all related to children (n=5), adolescents (n=6) and both (n=5). Results: the mean of shared meals was 1x/day, with a prevalence of 27 to 81%. Most studies (n=13) reported the beneficial impact on BMI, higher consumption of fruit and vegetables, protein, calcium and a lower consumption of sweets and sugar sweetened beverages, family union and self-regulation of appetite. Conclusions: having daily family mealtime has beneficial effect on the nutritional status and children and adolescents' eating behavior.

Resumo Objetivos: revisar a prevalência da prática de refeições em família e seu impacto no IMC e no comportamento alimentar durante a infância e adolescência. Métodos: revisão nas bases Bireme / Lilacs / Scielo / Cochrane e Pubmed, entre 2000 a 2016, com descritores "refeição em família", "comportamento", "alimentação ou dieta ou ingestão alimentar" e "criança/adolescentes"; realizada por dois examinadores independentes e segundo etapas sistemáticas, em inglês e português. Foram selecionados trabalhos que apresentassem a prevalência e/ou discussão de relações entre variáveis nutricionais. Foram encontrados 2319 artigos, dos quais 15 foram selecionados, todos na língua inglesa: revisões sistemáticas (n=2), estudos transversais (n=8), estudos longitudinais (n=8); todos com crianças (n=5), adolescentes (n=6) e ambos (n=5). Resultados: a média de compartilhamento de refeições foi de 1x/dia, com prevalência de 27 a 81%. A maioria dos estudos (n=13) descreveu impacto benéfico sobre o IMC, maior consumo de FLV, proteínas, fontes de cálcio e menor consumo de doces e bebida adoçadas, união familiar e auto regulação do apetite. Conclusões: a realização das refeições em família diariamente exerce efeito benéfico sobre o estado nutricional e comportamento alimentar de crianças e adolescentes.

Maternal Feeding Practices among Children with Feeding Difficulties-Cross-sectional Study in a Brazilian Reference Center.

BACKGROUND: Given the positive influence of responsive caregiving on dietary habits in childhood, to raise awareness of caregivers regarding their behavior is crucial in multidisciplinary care on infant feeding. OBJECTIVES: To identify the most common responsive and non-responsive feeding practices in mothers of children with feeding complaints, as well as to seek associations between practices and caregivers' profile. METHODS: Cross-sectional study with 77 children under 18 years old, with complaints of feeding difficulties. Data were collected during interviews with mothers: child age, gender, duration of exclusive breastfeeding, presence of organic disease, dynamics of bottle use, self-feeding practices and posture at meals, use of appropriate feeding equipment; basic information about the mothers (parity and level of education), caregiver feeding style, presence of coercive feeding, frequency and characteristics of family meals. Statistical analysis considered significance level at 5%. RESULTS: The non-responsive profile predominated among mothers (76.2%, with the Authoritarian style being the most prevalent-39.7%). The responsive profile was characterized by absence of coercive feeding, stimulation of self-feeding practices, use of appropriate feeding equipment and meal environment, with interaction at meals. Non-responsive profile consisted of both inadequate environment and posture at meals, use of distraction and coercive feeding, lack of shared meals, and disregard for children's hunger signals. Only the habit of sharing meals with children was associated with mothers' profile, and considered a protection factor against non-responsive care (OR 0.23; 95% CI 0.06-0.88). Both Authoritarian (p = 0.000) and indulgent mothers (p = 0.007) breastfed exclusively for longer time than negligent ones. There was a higher level of interaction with children in "responsive" parental style (OR 0.056; p = 0.01) compared to other feeding styles. CONCLUSION: Results highlight the need for educational interventions focused on caregivers' behaviors.

Resiliência: uma alternativa na abordagem da obesidade em adolescentes? / Psychological resilience: an alternative approach in the treatment of obesity in adolescents?

Estudo descritivo realizado na Clínica de Adolescência do Departamento de Pediatria da Santa Casa de Misericórdia de São Paulo com pacientes adolescentes do sexo feminino, n=55. Objetivo: Avaliar qualitativamente a resiliência de adolescentes obesos e com sobrepeso, comparando-a com eutróficos. Métodos: Realizada aplicação de questionário adaptado baseado no The Resiliency Quiz (Nan Henderson, MSW). Resultados: Testou-se a hipótese de que meninas obesas ou em sobrepeso seriam menos resilientes do que as eutróficas. Não houve significância estatística nos resultados. Conclusão: A amostra estudada se apresenta com bom nível de fatores promotores de resiliência, abrindo-se a discussão de que obesos e pacientes em sobrepeso tenham capacidade de resiliência igual aos eutróficos, ao menos nos pontos analisados.