Feeding Refusal Research Articles

Evaluate the Frequency of EosinophilicEsophagitisin Individuals with Refractory GERD

Background: Theeosinophilic infiltrate of the esophagus mucosal distinguishes the esophageal ailment known as Eosinophilicesophagitis (EoE). This study aims to determine the frequency of EoE in patients with gastroesophageal reflux disease (GERD), a gastro esophageal reflux condition that is persistent. Methods: The 248 children in total hadelectiveupper gastrointestinal endoscopy (UGIE) during the study period were separated in tosix groups: individuals without a history of steroid usage and those with outanesophageal biopsyforthrombocytopenia. As a result, 200 people participated in the study total. Results: After an evaluation of 200 children having elective UGIE, A variety of health problems were found during the investigation, including food bolusimpact (2 %), achalasia cardia (5 %), pepticstricture (6 %), congenitalstricture (3 %), post-esophageal atresia repairanastomoticstricture (4 %), and symptoms of gastro esophageal reflux, including vomiting (10 %), regurgitation (2 %), belchingchest (1,5 %), nocturnal cough (2,5 %), pain/heartburn (12,5 %), and feeding refusal (1 %). There were several unusual illnesses that were observed, including Crohn's disease accounted for 2 %, paediatric intestinal pseudo-obstruction (10 %), abdominal discomfort (17,5 %), celiacdisease (16 %), cow's milk protein allergy (3 %), and un classified IBD (7 %). Conclusion: EoEfrequently affects GERD patients who are recalcitrant to treatment. Dysphagia, food impaction, and heartburn are posible symptoms. EGD and esophageal biopsy should be explored for EoEscreening in elderly individuals with strong GERD who are atopy positive and who have not responded to gastric acid inhibitors.

The Frequency of Hypoglycemia and Its Symptoms in Preterm Neonates in the First 24 Hours.

Introduction Hypoglycemia is a critical concern in neonatal care, particularly among preterm infants. This study aims to investigate the frequency of hypoglycemia within the first 24 hours of life in preterm neonates, considering factors such as gestational age (GA), birth weight, and gender. Materials and methods A cross-sectional study was conductedfrom February to August 2021. The sample comprised 186 preterm infants selected through consecutive sampling. Data collection involved demographic information, glucose level monitoring, and symptom assessment. Results Of the 186 preterm neonates, 31.7% (n=59) experienced hypoglycemia within the first 24 hours, with feeding refusal being the predominant symptom. There was a significant difference in hypoglycemia occurrence between infants born before and after 32 weeks of gestation (p<0.05). Males were slightly more affected than females, although not statistically significant. Infants weighing less than 2 kg showed a higher susceptibility to hypoglycemia. Conclusion The early detection and management of hypoglycemia are crucial in preterm neonatal care. Close monitoring, especially in the initial four hours, is essential to prevent complications. Larger studies are warranted to confirm these findings and improve understanding and management strategies for hypoglycemia in preterm neonates, particularly within the first 24 hours of life.

A CASE OF HAIR THREAD TOURNIQUET SYNDROME OF THE TOE IN A MALE NEWBORN

Hair-thread Tourniquet Syndrome (HTTS), despite being widely reported, is often not well recognized. It is a rare surgical emergency. This syndrome involves the external, mechanical, circumferential constriction of an appendage by human hair, typically a digit, leading to a condition similar to compartment syndrome. If not treated promptly, it can lead to prolonged ischemia, potentially causing tissue necrosis or autoamputation of the affected digit. Herein, we report a four-day-old newborn from a low socioeconomic background was admitted with fever and feeding refusal. Clinical examination revealed a swollen and red big 4thtoe with a hair-thread tourniquet. No signs of toe ischemia were noted. A diagnosis of maternal-fetal infection with a meningeal focus was made, along with toe tourniquet syndrome. Radiography showed no bone lesion. The patient was treated with antibiotics and a healing cream.

Clinical aspects of human Bocavirus 1 in a sample of Egyptian infants with acute lower respiratory tract infection: A pilot study

Background/aim The recent advance in molecular technology permitted a comprehensive range of novel viral etiological causes to be detected in respiratory tract specimens. The human Bocavirus 1 (HBoV1) as a virus of the Parvoviridae family recently was defined as a human pathogen mainly linked to acute respiratory infection in children. Our aim was to identify the rate and seasonal variation of Bocavirus 1 infection and their correlation with the different clinical presentations in Egyptian infants less than 2 years old with acute lower respiratory tract infection. Patients and methods This study enrolled 100 infants aged from 4 weeks to 2 years presenting with symptoms of acute respiratory infection from Materia Hospital and Alzahraa University Hospital. Full medical history, general and local examination of the chest focusing on respiratory rate and plain chest radiograph were collected from each infant. In addition, pharyngeal swabs were collected from participated infants and were subjected to DNA extraction followed by PCR using different viral protein-targeted primer sets. Results Bronchopneumonia was the prominent diagnosis in the enrolled infants (38%) followed by bronchiolitis (34%) and bronchitis (28%) subsequently. The presence of HBoV1 among studied patients was 8% and the peak of the infection was in January (37.5%) followed by April (25%) and July (25%). Most of patients with HBoV1 positive were presented with respiratory distress and refusal of feeding. Seven percent of all patients were presented with diarrhea. Conclusions HBoV1 infection may be considered as a risk factor for lower respiratory tract infections in Egyptian children less than 2 years old.

Growth, tolerance and safety outcomes with use of an extensively hydrolyzed casein-based formula in infants with cow's milk protein allergy.

To evaluate growth, tolerance and safety outcomes with use of an extensively hydrolyzed casein-based formula (eHCF) in infants with cow's milk protein allergy (CMPA). A total of 226 infants (mean ± SD age: 106.5 ± 39.5 days, 52.7% were girls) with CMPA who received eHCF comprising at least half of the daily dietary intake were included. Data on anthropometrics [weight for age (WFA), length for age (LFA) and weight for length (WFL) z-scores] were recorded at baseline (visit 1), while data on infant feeding and stool records, anthropometrics and Infant Feeding and Stool Patterns and Formula Satisfaction Questionnaires were recorded at visit 2 (on Days 15 ± 5) and visit 3 (on Days 30 ± 5). From baseline to visit 2 and visit 3, WFA z-scores (from -0.60 ± 1.13 to -0.54 ± 1.09 at visit 2, and to -0.44 ± 1.05 at visit 3, p < 0.001) and WFL z-scores (from -0.80 ± 1.30 to -0.71 ± 1.22 at visit 2, and to -0.64 ± 1.13 at visit 3, p = 0.002) were significantly increased. At least half of infants never experienced irritability or feeding refusal (55.7%) and spit-up after feeding (50.2%). The majority of mothers were satisfied with the study formula (93.2%), and wished to continue using it (92.2%). In conclusion, eHCF was well-accepted and tolerated by an intended use population of infants ≤ 6 months of age with CMPA and enabled adequate volume consumption and improved growth indices within 30 days of utilization alongside a favorable gastrointestinal tolerance and a high level of parental satisfaction.

Clinical Pattern and Malnutrition among Children with Congenital Heart Disease at Tertiary Care Hospital

Background and Aim: Congenital heart disease is defined as the heart or intra-thoracic great vessel structural abnormalities present since birth with significantly functional irrespective of their detection age. It is the most prominent congenital anomaly and cause of morbidity and mortality among the pediatric age group population. The present study aimed to investigate the clinical pattern and malnutrition among children with congenital heart disease. Methodology: This descriptive cross-sectional study was carried out on 132 congenital heart disease patients in the Department of Pediatric, Imran Idrees Teaching Hospital Sialkot from January 2021 to December 2021. Children with clinical basis of cyanosis, feeding refusal, decreased activity, cough, hurried breathing, fever, and excessive sweating were enrolled. Acquired heart diseases and post-operative cardiac cases were excluded. Eligible children were assessed for sociodemographic details, physical examination, nutritional status, history, and types of congenital heart diseases. SPSS version 25 was used for data analysis. Results: Of the total 132 CHD children, there were 92 (69.7%) male and 40 (30.3%) females. The prevalence of acyanotic heart diseases, cyanotic heart diseases, complex CHD, and valvular diseases were 98 (74.2%), 22 (16.7%), 10 (7.6%), and 2 (1.5%) respectively. Age-wise distribution of all the children were as follows: 38 (28.8%) &lt; 1 month, 62 (47%) 1 month-1 year, 20 (15.2%) 1-5 years, and 12 (9.1%) 5-10 years. Based on presented symptoms, the incidence of breathlessness, fever, cough, and other symptoms were 68 (51.5%), 58 (43.9%), 54 (40.9%), and 49 (37.1%) respectively. The incidence of protein-energy malnutrition and normal cases were 72 (54.5%) and 60 (45.5%) respectively. Anemia was the most prevalent risk factor CHD in 52 (39.4%) cases followed by pneumonia 41 (31.1%). Conclusion: The present study concluded that acyanotic heart diseases were the most commonly found in children followed by cyanotic, complex, and valvular diseases. Infancy and childhood age are more susceptible to congenital heart diseases. Breathlessness and fever were the most common symptoms. Nutritional anemia followed by pneumonia and failure to thrive were the major risk factors for congenital heart diseases among children. Keywords: Congenital heart diseases, Clinical pattern, Malnutrition

Desfechos de deglutição e alimentação associados à intubação orotraqueal e à traqueostomia em pediatria

ABSTRACT Purpose To verify the swallowing and feeding outcomes of pediatric patients undergoing prolonged OTI, considering those who progressed to tracheostomy afterward. Methods Retrospective cohort study, carried out by analyzing the medical records of patients admitted to the Pediatric ICU and followed up until hospital discharge, between 03/2017 and 12/2018. Results Of the 51 patients included, 64.7% were male and the median age 6.7 months. Patients undergoing OTI for a median of 7 days had mild dysphagia and when submitted for more than 14 days had moderate/severe dysphagia and PFD with characteristics of food refusal, with contraindication to oral feeding at hospital discharge. 74.5% of the patients underwent OTI only and 25.5% progressed to tracheostomy afterward. Tracheostomized patients had a higher occurrence of hospital discharge with moderate/ severe oropharyngeal dysphagia, pediatric feeding disorder (PFD) with characteristics of food refusal and alternative method of feeding compared to patients without tracheostomy (p=0.001). Non-tracheostomized patients had a final diagnosis with milder degrees of dysphagia when compared to the initial diagnosis (p&lt;0.001). Conclusion The time of OTI and the presence of tracheostomy are factors associated with the speech-language pathology diagnosis of moderate/severe oropharyngeal dysphagia, presence of signs of PFD with characteristics of food refusal and the need for an alternative method of feeding that persists until hospital discharge, being frequent findings among the swallowing/feeding outcomes in pediatrics.

Occupational Therapy Assessment and Intervention of a 22 Month Old Girl with Feeding Refusal

Feeding difficulties, resulting from refusal to eat certain foods, are a frequent complaint in pediatric clinical practice. In many instances the initial situation is not necessarily serious but ongoing issues around feeding may lead to the adoption of inappropriate feeding practices that can have long lasting consequences. An extremely selective food choice, or picky eating, has been linked to sensory reactivity difficulties. In the general population it is estimated that between 5-10% of children experience sensory reactivity issues. Understanding how this can affect participation in feeding and mealtime is critical. This article presents a case report of a 22-month year old girl with selective food choices and feeding refusal. Occupational Therapy intervention based on Ayres Sensory Integration®, in the context of collaboration with the child’s pediatrician, was used to address the sensory issues underlying this child’s feeding and mealtime participation difficulties. From the results of the assessment, the following hypothesis were made; a) over-reactivity to oral and tactile sensory input was affecting acceptance of new foods and textures, b) vestibular processing difficulties and tactile over-reactivity were impacting this child´s ability to regulate level of alertness and the ability to stay sitting at the table during appropriate periods of time. Following the Occupational Therapy intervention this child showed improved feeding and mealtime participation and was also able to adequately sit at the table for the duration of the meal.

Türkiye‘den İlk Yenidoğan Koronavirüs Hastalığı 2019 (COVID-19) Vakası

Newborn cases commonly have milder COVID-19 disease. However, this is not enough to define knowledge about clinical manifestation and prognosis of this disease in newborns. A 17-day-old male neonate was admitted to the emergency room with fever and refusal to breastfeed at March 12, 2020. His pharyngeal swab testing was positive with real-time reverse transcription polymerase chain reaction (rRT-PCR) assay for SARS-CoV-2. Except his father, all his close contacts were asymptomatic and screened for SARS-CoV-2 and all his close contacts have revealed as positive. During this very contagious outbreak, the COVID-19 disease should be considered in newborns with fever or refusal of feeding.

Foreign body ingestion in children: Beware of disk batteries and multiple magnets.

Foreign body ingestion in children is a challenging clinical scenario. Children may be completely asymptomatic or present with overt symptoms, including drooling, dysphagia, chest pain, and feeding refusal (1, 2, 3). The majority of ingested foreign bodies passes spontaneously along the gastrointestinal (GI) tract and causes no harm nor symptoms.

Assessing the appropriateness of the management of gastro-oesophageal reflux in Australian children: a population-based sample survey

Gastro-oesophageal reflux (GOR) is a common physiological state in infants and young children, with gastro-oesophageal reflux disease (GORD) its pathological manifestation. Management of GOR/GORD requires elimination of possible underlying causes, parental reassurance, modification of feeding and symptom mitigation, monitoring, and referral to paediatricians if warning signs are present. Published clinical practice guidelines (CPGs) seek to support clinicians and improve management. This study aimed to measure the proportion of Australian GOR/GORD paediatric care that was in line with CPG recommendations. National and international CPGs for GOR/GORD were systematically identified and candidate indicators extracted; a Delphi process selected 32 indicators relevant to Australian paediatric care in 2012 and 2013. Medical records were identified in General Practices, the offices of general paediatricians, Emergency Departments and inpatient settings. Adherence to indicators was assessed by nine trained paediatric nurses undertaking retrospective medical record review. Medical records were reviewed in 115 healthcare sites; identifying 285 children, three-quarters aged < 1 year, who had 359 visits for management of GOR/GORD; 2250 eligible indicator assessments were performed. Estimated adherence rates are reported for 21 indicators with ≥ 25 assessments. Five indicators recommending differential diagnostic tests (e.g., urinalysis) for infants presenting with recurrent regurgitation and poor weight gain had ~ 10% adherence; conversely, avoidance of unrecommended tests (e.g., barium swallow and meal) was high (99.8% adherence: 95% CI 97.0–100). Avoidance of prescription of acid-suppression medication for infants at the first presentation was higher if they were healthy and thriving (86.9% adherence: 95% CI 86.0–96.8), intermediate if they had feeding refusal (73.1%: 95% CI 56.0–86.3) and lower if they presented with irritability and unexplained crying (58.8%: 95% CI 28.2–85.0). A guideline targeting Australian health professionals caring for infants and children with GOR/GORD is warranted, highlighting the importance of differential diagnostic testing and avoidance of acid-suppression medication in infants.

Occupational Therapy Assessment and Intervention of a 22 Month Old Girl with Feeding Refusal

Feeding difficulties, resulting from refusal to eat certain foods, are a frequent complaint in pediatric clinical practice. In many instances the initial situation is not necessarily serious but ongoing issues around feeding may lead to the adoption of inappropriate feeding practices that can have long lasting consequences. An extremely selective food choice, or picky eating, has been linked to sensory reactivity difficulties. In the general population it is estimated that between 5-10% of children experience sensory reactivity issues. Understanding how this can affect participation in feeding and mealtime is critical. This article presents a case report of a 22-month year old girl with selective food choices and feeding refusal. Occupational Therapy intervention based on Ayres Sensory Integration®, in the context of collaboration with the child’s pediatrician, was used to address the sensory issues underlying this child’s feeding and mealtime participation difficulties. From the results of the assessment, the following hypothesis were made; a) over-reactivity to oral and tactile sensory input was affecting acceptance of new foods and textures, b) vestibular processing difficulties and tactile over-reactivity were impacting this child´s ability to regulate level of alertness and the ability to stay sitting at the table during appropriate periods of time. Following the Occupational Therapy intervention this child showed improved feeding and mealtime participation and was also able to adequately sit at the table for the duration of the meal.

Occupational Therapy Assessment and Intervention of a 22 Month Old Girl with Feeding Refusal

Feeding difficulties, resulting from refusal to eat certain foods, are a frequent complaint in pediatric clinical practice. In many instances the initial situation is not necessarily serious but ongoing issues around feeding may lead to the adoption of inappropriate feeding practices that can have long lasting consequences. An extremely selective food choice, or picky eating, has been linked to sensory reactivity difficulties. In the general population it is estimated that between 5-10% of children experience sensory reactivity issues. Understanding how this can affect participation in feeding and mealtime is critical. This article presents a case report of a 22-month year old girl with selective food choices and feeding refusal. Occupational Therapy intervention based on Ayres Sensory Integration®, in the context of collaboration with the child’s pediatrician, was used to address the sensory issues underlying this child’s feeding and mealtime participation difficulties. From the results of the assessment, the following hypothesis were made; a) over-reactivity to oral and tactile sensory input was affecting acceptance of new foods and textures, b) vestibular processing difficulties and tactile over-reactivity were impacting this child´s ability to regulate level of alertness and the ability to stay sitting at the table during appropriate periods of time. Following the Occupational Therapy intervention this child showed improved feeding and mealtime participation and was also able to adequately sit at the table for the duration of the meal.

Effect of Temperature and Prey Quality on Aphid-Predator Interrelations in Two Spiders Associated with Aphids on Legumes and Cereal Crops in Egypt

The effect of temperature and prey quality of aphid species life, stage and their basic nutritional components on food consumption, predation rate and duration of development of spiderlings of Thanatus albini reared on a monotypic diet of immatures or adult females of each of Aphis craccivora and Rhopalosiphum maidis were studied at 3 different temperatures of 15, 27 and 35±2˚C and RH of 60-70%. Also, effects of the prey quality of the monotypic diet of each aphid on the tested parameters were studied in spiderlings of Thomisus spinifer and on reproduction in adult females of both spider species at 27˚C. Of the three tested temperatures, 27˚C was considered as the optimum temperature for aphid consumption and predation rate of spiderlings of Th. albini when fed on each of the two aphid species, due to increasing the two parameters and prolonging spiderling durations. Also, life, development of spiderlings and female reproduction of each of Th. albini and T. spinifer were maintained and completed at the optimum temperature of 27 by feeding on immatures or adult female aphids (except the first three spiderlings) of each of A. craccivora and R. maidis in Th. albini and only of R. maidis in T. spinifer. The two spider species showed efficacy as predators, consuming higher numbers of immatures than adults of each of the two aphid species with more consumption of A. craccivora than R. maidis in Th. albini and only of R. maidis in T. spinifer with the refusal of feeding on A. craccivora. The number of consumed aphids by each spider species was increased by increasing the age of the spiderling stage. Quantitative analysis of the basic nutritional components showed a higher concentration of total protein and carbohydrate in adult females than immatures of each aphid species but no significant difference between each of the immatures and adult females of the two aphid species. The significance of the obtained results was discussed.

Sudden Chest Pain Due to Esophageal Intramural Dissection

Sudden Chest Pain Due to Esophageal Intramural Dissection

The Safety and Efficacy of Lansoprazole plus Metoclopramide among Neonates with Gastroesophageal Reflux Disease Resistant to Conservative Therapy and Monotherapy: A Clinical Trial.

Background Gastroesophageal reflux disease (GERD) is one of the most common problems in neonates. The main clinical manifestations of neonatal GERD are frequent regurgitation or vomiting associated with irritability, crying, anorexia or feeding refusal, failure to thrive, arching of the back, and sleep disturbance. Aims The efficacy and safety of ranitidine plus metoclopramide and lansoprazole plus metoclopramide in reducing clinical GERD symptoms based on I-GERQ-R scores in neonatal GERD resistant to conservative and monotherapy. Study Design. This study was a randomized clinical trial of term neonates with GERD diagnosis (according to the final version of the I-GERQ-R), resistant to conservative and monotherapy admitted to Bahrami Children Hospital during 2017-2019. Totally, 120 term neonates (mean age 10.91 ± 7.17 days; girls 54.63%) were randomly assigned to a double-blind trial with either oral ranitidine plus metoclopramide (group A) or oral lansoprazole plus metoclopramide (group B). The changes of the symptoms and signs were recorded after one week and one month. At the end, fifty-four neonates in each group completed the study and their data were analyzed. Results There was no significant difference in demographic and baseline characteristics between the two groups. The response rate of “lansoprazole plus metoclopramide” was significantly higher than “ranitidine plus metoclopramide” (7.44 ± 3.86 score vs. 9.3 ± 4.57 score, p = 0.018) after one week and (2.41 ± 3.06 score vs. 4.5 ± 4.12 score, p = 0.003) after one month (primary outcome). There were no drug adverse effects in either group during intervention (secondary outcome). Conclusions The response rate was significant in each group after one week and one month of treatment, but it was significantly higher in the “lansoprazole plus metoclopramide” group compared with the “ranitidine plus metoclopramide” group. The combination of each acid suppressant with metoclopramide led to a higher response rate in comparison with monotherapy used before intervention. This study has been registered at the Iranian Registry of Clinical Trails (RCT20160827029535N3).

Survey of Psychosocial Issues of Nasogastric Tube Feeding in Head-and-Neck Cancer Patients.

Background:Because of some psychosocial reasons and misbelieves regarding nasogastric(NG) tube feeding, many patients refuse for NG tube insertion.Aim:Primary aim was to do survey of psychological reasons for refusal of NG tube insertion and feeding in head and neck cancer patients. Secondary aim was to assess impact of psychological counseling of patient who did not accept NG tube feeding.Method:This cross sectional study was conducted on patients referred to palliative medicine department and needed NG tube feeding but refused for the same. We prepared our own questionnaire which includes the most common cause for enteral feeding refusal which we found during our routine OPD since last five years response to those questions were recorded. Then we did psychological counseling of patients and again we assessed patient's acceptability for NG tube feeding by Likert scale and record their response.Results:Most common psychological reasons for patient's refusal were “it will disrupt my body image”(88.33%), “unable to go outside/mix with people”(80%) and “dependency on others for activities”(66.66%). Post psychological counseling out of 60 patients 47 patients were agreed while 13 patients did not agree with NG tube feeding (P value 0.000062<0.5).Conclusion:We conclude that though NG tube feeding is necessary for some head and neck cancer, there are lots of psychosocial problem regarding its acceptance for patients. For that adequate psychological assessment and counseling is necessary for patients' acceptance, compliance and good quality of life.

Disruptions in the development of feeding for infants with congenital heart disease.

Congenital heart disease (CHD) is the most common birth defect for infants born in the United States, with approximately 36,000 affected infants born annually. While mortality rates for children with CHD have significantly declined, there is a growing population of individuals with CHD living into adulthood prompting the need to optimise long-term development and quality of life. For infants with CHD, pre- and post-surgery, there is an increased risk of developmental challenges and feeding difficulties. Feeding challenges carry profound implications for the quality of life for individuals with CHD and their families as they impact short- and long-term neurodevelopment related to growth and nutrition, sensory regulation, and social-emotional bonding with parents and other caregivers. Oral feeding challenges in children with CHD are often the result of medical complications, delayed transition to oral feeding, reduced stamina, oral feeding refusal, developmental delay, and consequences of the overwhelming intensive care unit (ICU) environment. This article aims to characterise the disruptions in feeding development for infants with CHD and describe neurodevelopmental factors that may contribute to short- and long-term oral feeding difficulties.

Maternal postpartum feeding anxiety was associated with infant feeding practices: results from the mother-infant cohort study of China

BackgroundMaternal feeding anxiety (FA) was prevalent during puerperium and might affect infant feeding practices. This study was aimed to investigate the FA status in Chinese postpartum women and its relationship with infant feeding practices (FPs).MethodsParticipants were from the Mother-Infant Cohort Study of China, in which the dietary and feeding practices, physical and psychiatric health for both mothers and infants were followed up from childbirth to next 2 years. In this study the maternal feeding anxiety (FA) status at 0–3 months postpartum was assessed by Li’s Self-rating Feeding Anxiety Scale (SFAS). Infant feeding practices (FPs) at 0–3 months, including breastfeeding-related behaviors, responsive feeding and infant food refusal were investigated by self-designed questionnaire.ResultsIn total 456 mothers the average feeding anxiety scores (FAS) was 41.02 ± 8.02 (mean ± SD), and maternal FA prevalence were 61.4% (FAS>38) with severe FA being 8.6% (FAS>52) at 0–3 months postpartum. The FAS was related with infant FPs, and lower maternal FAS was significantly related with infant colostrum feeding (40.86 ± 8.02 vs 44.74 ± 11.33, P < 0.05), but higher FAS was related with bottle feeding (41.95 ± 8.28 vs 39.69 ± 7.92, P < 0.05). The mothers with severe feeding anxiety (FAS > 53) were more likely to feed infants with bottle (ORs, 95%CI: 2.41, 1.11 ~ 5.19). There were not significant association between FAS and exclusive breastfeeding and responsive feeding practices (P > 0.05). The higher FAS was associated with infant food refusal behaviors, the maternal scores whose infant “never”, “rarely”, “sometimes” and “often” spat out food when feeding were 39.86 ± 8.02, 41.47 ± 8.18, 41.36 ± 7.44 and 42.14 ± 12.03 increasingly (P > 0.05), and the FA prevalence was significantly different among groups (P < 0.05). The infants whose mother was identified as feeding anxiety were more likely to refuse opening the mouth when feeding (P < 0.05). Multivariate analysis indicated maternal FAS was positively related to infant bottle feeding (βi = 2.487, P < 0.05) and outdoor sunshine exposure practice (βi = 1.787, P < 0.05), and negatively related to household income level (βi = − 0.118, P < 0.05).ConclusionsMaternal postpartum feeding anxiety was associated with some infant feeding practices, including bottle feeding and infant food refusal behaviors.

Eosinophilic Esophagitis in Children: Clinical Findings and Diagnostic Approach.

Eosinophilic esophagitis (EoE) is an emerging chronic immune and antigen-mediated clinicopathologic disease. During the last 2 decades, the incidence of this condition in children has increased significantly, thanks to practitioners for creating the awareness and higher use of diagnostic endoscopy. We have analysed paediatric literature on EoE focusing on the epidemiology, pathophysiology, clinical findings and diagnostic approach.EoE is pathogenically related to a Th2 inflammation characterized by a mixed IgE and non-IgE-mediated reaction to food and/or environmental agents. This leads to esophageal dysfunction and remodeling accompanied by subepithelial fibrosis. EoE can be presented with several range of gastrointestinal symptoms, including regurgitation, vomiting, feeding difficulties or feeding refusal in infants and toddlers, as well as heartburn, dysphagia and food bolus impaction in older children and adults. The diagnostic suspicion is based on the presence of chronic symptoms of esophgeal dysfunction and esophageal eosinophilia characterised histologically by a significant eosinophilic infiltration of the oesophageal mucosa (>15 eosinophils per high powered field). In this review, we will provide an update on clinical presentation and diagnostic approach to EoE in children. We emphasized on the relevant aspects of the new clinical condition termed “PPI responsive esophageal eosinophilia”, as entities distinct from EoE and the role of PPI trial in the diagnostic workup, therefore we proposed a new diagnostic algorithm.