Infant feeding practices and later parent-reported feeding difficulties: a systematic review.

CONTEXT: Early feeding practices may influence the acceptance of new foods and contribute to the development of feeding difficulties later in childhood. OBJECTIVE: The aim of this systematic review was to evaluate the association of breastfeeding duration, timing of complementary feeding introduction, and feeding techniques with feeding difficulties or their subtypes, namely picky or fussy eating, food refusal, and food neophobia, in children older than 1 year of age. DATA SOURCES: Guidance from the Cochrane Collaboration and the Centre for Reviews and Dissemination was followed. MEDLINE, Embase, and PsycINFO databases were searched up to December 2019. Additionally, references from included articles were screened. STUDY SELECTION: Interventional and observational studies were eligible. Of the 3653 records obtained after the search strategy was applied, 21 observational studies (cohort, case-control, cross-sectional), many with important methodological limitations, and 1 randomized controlled trial were included. DATA EXTRACTION: Three authors extracted data independently. RESULTS: Results were synthesized narratively. Twelve observational studies assessed the association of breastfeeding duration with parent-reported feeding difficulties. Longer duration of breastfeeding tended to be associated with fewer childhood feeding problems in the majority of studies, but the differences were often small and not significant. Eight observational studies that examined the timing of complementary feeding introduction in relation to parent-reported feeding difficulties showed inconsistent results. Baby-led weaning, as compared with spoon-feeding, was significantly associated with less fussiness at age 12 to 36 months in 1 of 5 studies. CONCLUSIONS: This review showed no strong evidence to support the hypothesis that early feeding practices contribute significantly to specific parent-reported feeding difficulties in children older than 1 year of age. Additional methodologically rigorous studies are needed to confirm these findings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number CRD42018115792.

Translation to Polish, cross-cultural adaptation, and validation of the Bristol Stool Form Scale among healthcare professionals and patients.

INTRODUCTION: The seven-point Bristol Stool Form Scale (BSFS), which refers to seven pictures of different forms of stool, is a commonly used instrument to assess stool consistency. AIM: To translate, cross-culturally adapt, and validate the BSFS for its use in Poland. MATERIAL AND METHODS: The steps included forward translation, reconciliation, backward translation, comparison of the two English versions and validation of the translation, pilot testing, proofreading, approval of the final version of the target language BSFS, and validation. The latter process involved healthcare professionals (physicians and nurses), healthy adults, and adult patients with gastrointestinal disorders, who were asked to correlate images of seven types of stools with their descriptions. All available subjects were asked to repeat the survey to assess test-retest reliability. The primary outcome measures were validity (accuracy) and reliability (repeatability). RESULTS: A total of 320 subjects took part in the validation study (80/group). Overall, concordance between descriptions and pictures was 78.7%, and the overall κ index was good (0.75, 95% confidence interval (CI): 0.73 to 0.77). Test-retest assessment was performed in 170 (53.1%) subjects within a mean interval of 5.9 ±2.5 days. Overall, concordance between definitions and pictures for the re-testing phase was 90.7% with a κ index of 0.89 (95% CI: 0.87 to 0.91). CONCLUSIONS: As a result of the translation and cultural adaptation process, a final Polish version of the BSFS was created. The substantial validity and reliability of this Polish version was demonstrated.

In vivo assessment by parents and a physician using the Amsterdam Infant Stool Scale provided better inter-rater agreement than photographic evaluation.

AIM: This study assessed the inter-rater variability of stool assessment, comparing the judgement of parents and a physician using the Amsterdam Infant Stool Scale (AISS) and the evaluation by another physician using photographs. METHODS: The stools of children aged two to 18 months, who were not toilet-trained, were independently assessed in vivo using the AISS by the parents and the first physician. Another physician, unaware of the results of the in vivo evaluation, assessed two stool photographs taken by the first physician with a smartphone. RESULTS: Having analysed 100 stools, we found excellent inter-rater agreement between the parents and the first physician for consistency (κ: 0.87; 95% confidence interval [95% CI] 0.78-0.95) and colour (κ: 0.81; 95% CI: 0.71-0.91) and good inter-rater agreement for the amount (κ: 0.79; 95% CI 0.7-0.88). We found moderate inter-rater agreement between the parents' in vivo assessment and the second physician's photographic assessment for stool consistency (κ: 0.5; 95% CI 0.36-0.64) and amount (κ: 0.44; 95% CI 0.29-0.59) and a fair inter-rater agreement for colour (κ: 0.33; 95% CI 0.21-0.45). CONCLUSION: When parents and a physician used the AISS under in vivo conditions, there was better inter-rater agreement than photographic evaluation by a second physician.

Systematic review: probiotics for functional constipation in children.

We updated our 2010 systematic review on the efficacy of probiotics in the treatment of constipation in children. The MEDLINE, EMBASE, and Cochrane Library databases; clinical trial registries; and reference lists of included studies were searched to February 2017 for randomized controlled trials (RCTs) performed in children, with no language restriction. The primary outcome measure was treatment success, as defined by the investigators. We included seven RCTs with a total of 515 participants. Included trials were heterogeneous with respect to study population, probiotic strains, dosages, study duration, and follow-up. Pooled results of two RCTs showed no significant difference between the Lactobacillus rhamnosus casei Lcr35 and placebo groups with respect to treatment success. Other probiotics were studied in single trials only. There was no significant difference between the probiotic and control groups with respect to treatment success. While some probiotic strains showed some effects on defecation frequency, none of the probiotics had beneficial effects on frequency of fecal incontinence or frequency of abdominal pain. Adverse events were rare and not serious. CONCLUSION: Limited evidence does not support the use of any of currently evaluated probiotics in the treatment of functional constipation in children. What is Known: • Conventional treatment for functional constipation in children does not always provide satisfying improvement. • Probiotics have been suggested as potential treatment modalities for this condition. What is New: • Probiotics are ineffective for the management of functional constipation in children in terms of treatment success, frequency of fecal incontinence, and frequency of abdominal pain.

Lactobacillus casei rhamnosus Lcr35 in the Management of Functional Constipation in Children: A Randomized Trial.

OBJECTIVE: To assess the effectiveness of Lactobacillus casei rhamnosus Lcr35 (Lcr35) in the management of functional constipation in children. STUDY DESIGN: A randomized, double-blind, placebo-controlled trial was conducted in 94 children aged <5 years with functional constipation according to the Rome III criteria. Children were assigned to receive Lcr35 (8 × 108 colony-forming units, n = 48) or placebo (n = 46), twice daily, for 4 weeks. The primary outcome measure was treatment success, defined as 3 or more spontaneous stools per week, without episodes of fecal soiling, in the last week of the intervention. Analyses were by intention to treat. RESULTS: Eighty-one (86%) children completed the study. There was no significant difference in treatment success between the placebo and the Lcr35 group (28/40 vs 24/41, respectively; relative risk, 0.6, 95% CI 0.24-1.5, P = .4). There was a significant increase in the frequency of defecation from baseline to week 4 in both the placebo group (median [IQR] 2.0 [1.0, 2.0] to 6.0 [4.0, 9.0], P < .001) and in the Lcr35 group (2.0 [1.0, 2.0] to 4.0 [3.0, 5.0], P < .001), but the defecation frequency in the placebo group was significantly greater than that in the Lcr35 group at weeks 1, 2, 3, and 4. CONCLUSION: Lcr35 as a sole treatment was not more effective than placebo in the management of functional constipation in children <5 years. This study adds to current recommendations that do not support the use of probiotics in the treatment of childhood constipation. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01985867.

Enema versus polyethylene glycol for the management of rectal faecal impaction in children with constipation - a systematic review of randomised controlled trials.

INTRODUCTION: Rectal faecal impaction (RFI) from functional constipation is a common problem in children. Maintenance therapy should start after successful disimpaction. However, there is uncertainty with regard to the optimal disimpaction regimen. AIM: We systematically evaluated the effect of polyethylene glycol (PEG) compared to enema for treating RFI. MATERIAL AND METHODS: The MEDLINE, EMBASE, and the Cochrane Library, with no language restrictions, were searched up to July 2014 for randomised controlled trials (RCTs) evaluating the effect of PEG compared with enema for disimpaction in children with functional constipation. The risk of bias was assessed using the Cochrane risk of bias tool. RESULTS: Two RCTs, involving 170 children aged 1 to 17 years, met the inclusion criteria. The studies were generally low in methodological quality. Compared with the enema group, the PEG 3350 group had significantly reduced chance for treatment success, but the difference was of a borderline statistical significance (RR = 0.83, 95% CI: 0.7-0.99). The use of PEG was also more likely to increase defecation frequency, but increased the risk of watery stools and increased faecal incontinence. Other outcomes, in general, were similar in both groups. CONCLUSIONS: Current evidence does not allow us to conclude which intervention is more effective for treating RFI in children with functional constipation. These results should be interpreted with caution due to the limited number of trials and the low quality of reporting in these trials, high or unknown risk of bias, and sparse data. Further high-quality, adequately powered RCTs are needed to determine the optimal management.

Leonurus cardiaca L. (motherwort): a review of its phytochemistry and pharmacology.

Leonurus cardiaca is a perennial plant indigenous to central Europe and Scandinavia, but it is also found in the area spanning temperate Russia to central Asia. It has been introduced to North America and has become established locally in the wild. Motherwort (Leonuri cardiacae herba) consists of aerial parts of Leonurus cardiaca gathered during the flowering period, dried at 35 °C and, according to European Pharmacopoeia 7th edition, should contain a minimum of 0.2% flavonoids, expressed as hyperoside. Compounds belonging to the group of monoterpenes, diterpenes, triterpenes, nitrogen- containing compounds, phenylpropanoids, flavonoids and phenolic acids, as well as volatile oils, sterols and tannins, have been identified in motherwort. Traditionally, extracts of the herb have been used internally, mainly for nervous heart conditions and digestive disorders. However, they have also been used for bronchial asthma, climacteric symptoms and amenorrhoea, as well as externally in wounds and skin inflammations. Mild negative chronotropic, hypotonic and sedative effects can be attributed to the herb and preparations thereof. Pharmacological studies have confirmed its antibacterial, antioxidant, anti-inflammatory and analgesic activity, as well as its effects on the heart and the circulatory system. Sedative and hypotensive activity has been demonstrated in clinical trials.

[Coexistence of congenital heart diseases with other congenital defects]. / Wspólistnienie Wrodzonych Wad Ukladukrazenia Z Innymi Wadami Rozwojowymi.

AIM: Evaluating the prevalence and type of non-heart malformations in patients hospitalised in the Department of Pediatric Cardiology of the Children's Memorial Health Institute due to congenital pathology of the circulatory system; comparing the frequency of other congenital malformation in the group researched in relation to the population overall and evaluating their relevance to survival. MATERIAL AND METHODS: Research included 266 infants with heart defects. The patients' data were analysed in retrospect on the basis of medical records, taking into account the kind of heart defect, defects of other systems, and mortality in the first year of life. The frequency of non-heart congenital defects were compared with data from the Polish Registry of Congenital Malformations. RESULTS: In 71 children among 266 patients congenital defects of other systems were diagnosed. The group researched presented a significantly greater occurrence of such defects than the population overall (26.7% vs 1.81%). The most frequent diagnoses were: 1. chromosomal abnormalities (N=26; 9.77%), 2. malformations of the digestive system (N=7; 3.01%), 3. syndromes of multiple congenital defects (N=6 ; 2.26%). The defects usually coexisted with the atrio-ventricular septal defect (18 out of 22 patients - 81.8%) and rarely in neonates with duct-dependent defects (19 out of 122 patients - 15.6%). 32 children died, of whom 10 had congenital non-heart malformation in addition to congenital heart defects. No significant difference in the frequency of death was found in children who presented only with heart pathology in comparison to those with other defects (11.2% vs 14%). CONCLUSIONS: In patients with congenital heart defects other congenital malformations occurred more often than in all the population, especially chromosomal abnormalities, malformations of the digestive system and congenital malformation syndromes. Congenital malformations were not connected with higher mortality of children with heart defects.