Food Refusal Research Articles

Photobiomodulation for Lowering Pain after Tonsillectomy: Low Efficacy and a Possible Unexpected Adverse Effect.

Background: Tonsillectomy is one of the most common surgical procedures performed in children as a treatment for obstructive sleep apnea due to tonsil hypertrophy or highly recurrent tonsillitis. Odynophagia, associated with food refusal for the first few days, is a common post-operative complaint. Available drugs for pain management, while efficacious, present some drawbacks, and a novel strategy would be welcome. Photobiomodulation (PBMT), in this context, can represent a possible choice, together with pharmacological therapy. The aim of this study was to evaluate PBMT effects compared to standard pain therapy on nociceptive sensation at different time points and administration of painkiller. Methods: A registered, controlled, randomized, double-blind clinical trial was performed. Twenty-two patients were recruited and divided into laser-treated (T) or untreated (UT) groups, based on random assignment. In T group, immediately after tonsillectomy, performed with cold dissection technique, laser light was applied to the surgery site (using a Cube 4 from Eltech K-Laser s.r.l., Treviso, Italy), and then hemostasis was performed using bismuth subgallate paste. In C group, the same procedure was performed, except that laser light was switched off. The primary outcome was the difference in pain scores between subject receiving photobiomodulation (PBMT) and subjects receiving standard care after 24 h; the secondary outcomes were pain scores at awakening and at 48 h together with distress (delirium) at awakening. Results: Two patients from the T group experienced a post-surgery bleeding, and one of them required revision of the hemostasis under general anesthesia. A preliminary analysis of pain sensation reported by the patients or caregivers did not show differences between treated and untreated subjects. Conclusion: These data suggest that PBMT could increase post-surgical bleeding.

Associations of toddler mechanical/distress feeding problems with psychopathology symptoms five years later.

Feeding problems are common in early childhood, and some evidence suggests that feeding problems may be associated with psychopathology. Few prospective studies have explored whether toddler feeding problems predict later psychopathology. Mothers of 1,136 children from the Upstate KIDS cohort study provided data when children were 2.5 and 8 years of age. Food refusal (picky eating) and mechanical/distress feeding problems and developmental delays were assessed at 2.5 years. Child eating behaviors (enjoyment of food, food fussiness, and emotional under and overeating) and child psychopathology (attention-deficit/hyperactivity (ADHD), oppositional-defiant (OD), conduct disorder (CD), and anxiety/depression) symptoms were assessed at 8 years. Mechanical/distress feeding problems at age 2.5, but not food refusal problems, were associated with ADHD, problematic behavior (OD/CD), and anxiety/depression symptoms at 8 years in models adjusting for eating behaviors at 8 years and child and family covariates. Associations with mechanical/distress feeding problems were larger for ADHD and problematic behavior than anxiety/depression symptoms, though all were modest. Model estimates were similar for boys and girls. Much of the research on feeding problems focuses on picky eating. This study suggests that early mechanical and mealtime distress problems may serve as better predictors of later psychopathology than food refusal. Parents and pediatricians could monitor children with mechanical/distress feeding problems for signs of developing psychopathology.

Hunger strikes and differential consciousness: Impure contestation, hunger, and the building of symbolic futures

ABSTRACT Hunger strikes appear to occupy a liminal position within the literature of power and resistance, constituting a contradictory means of empowerment — weakening the body while politically strengthening the subject. As such, this tactic eludes classification, in fact operating as an impure form of contestation. Scholars have also revealed that food refusal operates as a primarily symbolic form of resistance. I extend these conclusions to understand how hunger strikers use impure and contradictory discourse to frame their food refusal, a tactic understood best through Chela Sandoval’s (2003) the notion of differential consciousness. Just as hunger strikes constitute an impure means of resistance, they also appear to prefigure opportunities for dynamic and impure modes of discursive contestation. Through analysis of social media communications, detainee letters, and press releases, I unpack efforts to engage and challenge the dynamic, overlapping, and seemingly contradictory hegemonic discourses of deservingness, rights, and family. I also elucidate how differential consciousness allows incarcerated hunger strikers and their supporters to build legitimate authority within recognizable relations while building space for alternative logics — drawing on hegemonic discourses to construct alternative possibilities. Hunger strikes offer unique insight into how the study of carceral foodways is not only about consuming food, but also about refusing it.

Biathanatos revisited: Anabaptist perspectives on voluntarily stopping eating and drinking in the face of terminal illness.

IntroductionVoluntarily Stopping Eating and Drinking (VSED) is a legal means of hastening death through refusal of food and fluids – a topic rarely addressed in Christian Protestantism. Among this group, U.S. Mainline Protestants comprise nearly 15% of the population and are more likely to include social moderates and liberals who emphasize quality of life (over mere life) and may therefore be open to the practice.ObjectivesLeveraging the well-established and validated Theory of Planned Behavior – that posits a person’s intentions to carry out an action are motivated by one’s attitude, perception of subjective norms, and perceived behavioral control – this research elucidates clergy and congregants’ normative beliefs and anticipated tactical support for VSED, including their reactions to Christian-based justifications for this end-of-life option. Such reasoning includes that VSED is a “fast into eternal life” and is based on the example of Jesus Christ, who, in the face of ongoing suffering, determined the end of his own life when he stated, “It is finished,” and gave up his spirit – an insight originally argued by John Donne in Biathanatos (1647/1982).MethodsThis case study of one southern Anabaptist congregation employs a focus group and one-on-one interviews, capturing reactions to a vignette in which a hypothetical fellow parishioner intends to VSED in the face of ongoing suffering from a terminal illness.ResultsIn response to the presented vignette, study participants reported their affirmation of VSED. Responses to faith-based justifications for the practice varied widely.ConclusionIndividuals aiming to VSED in the face of terminal illness may have their intention affirmed by a church community, but will likely require additional caregiving support to achieve a hastened death. A nascent framework for future comparative studies of faith communities’ assessments of VSED is also proposed.

Evaluation of the predictability of clinical and radiological findings in the diagnosis of malrotation.

To evaluate the predictability of clinical and radiological findings in the diagnosis of malrotation. Between 2010 and 2020, children with presumptive diagnosis of malrotation were included. The demographic features, clinical and radiological findings, operative findings and outcome were recorded. The upper gastrointestinal series (UGIS) were evaluated by two radiologists. All parameters were correlated with surgical findings to evaluate the predictability. Seventy patients were included. The presenting symptom was bilious vomiting in 29 cases (41.4%), and atypical symptoms (non-bilious vomiting, food refusal, etc.) in 40 cases (57%). One of the cases (1.6%) was asymptomatic and diagnosed incidentally during UGIS. 52 cases had abdominal X-ray and 14 (26.9%) of them were normal. Doppler ultrasonography (US) (n=20) revealed evidence of malrotation in 13 cases (65%). The location of duodenojejunal junction (DJJ) in UGIS was compatible with malrotation in 33 cases. 48 (61%) cases underwent surgical exploration; 35 cases had malrotation and seven cases had midgut volvulus. Median followup time was one year (0.5-7 years). Volvulus has recurred in one case and another case operated for volvulus died because of short bowel syndrome. The statistical analysis for predictability revealed that bilious vomiting (sensitivity: 57.1%, specificity: 82.1%), Doppler US (sensitivity: 92.3%, specificity: 75%) and right-sided DJJ in UGIS (sensitivity: 96.8%, specificity: 75%) have highest predictability. The bilious vomiting, Doppler US findings and right-sided DJJ have the highest predictability to confirm the diagnosis. However, presenting with atypical symptoms and having atypical or normal findings in UGIS do not rule out malrotation.

Inaugural Seizures Revealing COVID-19 in an Immunocompetent Infant at the University Teaching Hospital (UTH) of Bouaké

Introduction: Children are likely to present with atypical and non-specific clinical manifestations of COVID-19, unlike adults. The aim of this observation is to identify the difficulties related to the diagnosis and the curative and preventive management of SARS-CoV-2 infection in children. Observation: This is a 15-month-old infant admitted for febrile seizures. The interrogation revealed signs evolving 48 hours before his admission marked by post-prandial vomiting, wet cough, hypotonia, food refusal, incessant crying, fever, and seizures. His antecedents can be summed up as an uneventful pre- and per-natal period, good eating habits, good psychomotor and staturo-ponderal development, and outdated vaccination. The physical and paraclinical examination made it possible to retain the diagnosis of severe pneumonia. The initial management consisted of oxygenation, hydroelectrolyte intake, antibiotic therapy, and neurosedation. The evolution 3 days later was marked by a worsening of the clinical features, and the hypothesis of infection with SARS-CoV-2 was raised. The nasopharyngeal swab for COVID-19 RT-PCR performed was positive. The infant was isolated in the intensive care unit, where he received oxygen therapy with a mask, enteral nutrition, antibiotic therapy, corticosteroid therapy, and adequate nursing. The evolution was favorable 48 hours later. In addition, his asymptomatic mother and 14-year-old brother were placed in isolation after a positive RT-PCR COVID-19 test. Her father who was very often away from home for professional reasons was negative for COVID-19 RT-PCR. They all four live in the same 3-room house. Conclusion: Childhood COVID-19 has many facets. Clinicians should think about it in the face of any infectious manifestation, in order to avoid delays in treatment and improve the prognosis.

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<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.

A case of anorexia nervosa in a preadolescent male

Anorexia nervosa (AN) is one among the severe psychiatric disorders of adolescence. AN in boys is often overlooked by both physicians and psychiatrists since it is predominantly seen in females. Teenagers usually get over the disorder, but in some cases, AN can cause serious complications, including chronicity and death. AN is often encountered among females and more so in the affluent class. Here, we present an 11-year-old boy belonging to a middle-class Indian family, referred for psychiatric evaluation from the pediatrics department after ruling out all medical causes for the weight loss. The patient complained of loss of appetite along with weight loss of 14 kg in the last 3 months. In-depth psychiatric evaluation revealed significant distress of gaining weight as well as an intense disgust related to his body shape. A cluster of determined food refusal and weight loss triggered the exploration of other symptoms of AN. The patient responded to antidepressants and well-planned cognitive behavioral therapy. Results were seen in the form of return to the normal range of body weight, shape, and size along with its confident acceptance.

Eosinophilic esophagitis an update in children.

Eosinophilic esophagitis (EoE) is an emerging antigen-mediated, inflammatory disease of unknown etiology. EoE affects about 1/2,000 patients in the United States (US), with a higher prevalence rate in adults (43.4/100,000) than in children (29.5/100,000), prevailing in Caucasians and male sex. EoE is a multifactorial disease typically characterized by type 2 inflammation. Pathogenesis is not entirely understood and is likely non-IgE mediated. Food allergens trigger EoE, stimulating the dysregulated immune cells through an impaired esophageal epithelial barrier. Clinical presentation of EoE depends on age and mainly includes food refusal, vomiting, abdominal or chest pain, dysphagia, and food impaction. Endoscopy is the gold standard to diagnose EoE. The goal of EoE therapy is to achieve clinical and histological remission to prevent esophageal fibrosis and improve patients’ quality of life (QoL). Cornerstones of therapy are PPIs, topical steroids, and elimination diets. Over recent decades, research progress has been made in terms of a greater understanding of the EoE pathogenesis and new therapeutic approaches. However, there are still several unmet needs, such as non-invasive tools and biomarkers for monitoring the disease. (www.actabiomedica.it).

Prevalence of Child’s Behavioural Feeding Problems, Body Mass Index and Mental Health Issues Among Parents and Children with Autism in Malaysia

Autism Spectrum Disorder (ASD) is defined as a group of pervasive neurodevelopmental disorders that include significantly impaired functioning in terms of cognitive skills and socialization, verbal and receptive communication, and repetitive behaviors. Several problems arise when handling children with ASD which of them is related to eating behavior. The challenges in daily life that need to be faced by parents of ASD children during mealtime are increased food selectivity, food refusal, and problematic mealtime behaviors. A cross-sectional study was carried out to identify prevalence of child’s behavioural feeding problems, body mass index and mental health issue experience by both parents and children with ASD in Malaysia. A total of 213 parents participated in this study. Data on sociodemographic, eating behavior were collected using a questionnaire. Respondents completed the self-reported Sociodemographic form, anthropometry form and Behavioral Paediatric Feeding Assessment Scale (BPFAS) questionnaire, Strength and Difficulty questionnaire and answer 10-item perceived stress scale to evaluate the intended measures. The prevalence abnormal of eating behavior is higher among the participants was 80.8% (n=172). For BMI, 49.8% (n=106) of the respondents reported the highest prevalence of overweight. Peer and pro-social problems were the most frequently reported mental health issues among ASD children, but emotional, behaviour, and hyperactivity issues were reported less frequently. The majority of parents surveyed in this study assessed themselves to be under considerable stress (93.4 percent). In conclusion, this cross-sectional study demonstrated a high frequency of behavioural feeding difficulties, mental health concerns, and obesity among children with autism spectrum disorders in Malaysia. The findings from this study will contribute to the body of information regarding the nutritional health of children with autism spectrum disorders. The increased prevalence of overweight and obesity in children with ASD is one of the indicators that this study should investigate additional factors that may influence children's weight status.

Hyperoxaluria: An early diagnosis will allow a timely combined renal and liver transplantations to avoid irreversible damages to all other organs.

ABSTRACTA 4-month-old patient was admitted to the emergency room for vomiting, weight gain, food refusal and hypertension. Blood gases showed a metabolic acidosis with increased anion gap. Laboratory finding revealed severe renal failure (creatinine 8 mg/dL). Renal ultrasound showed an important hyperechogenicity of the parenchyma with loss of cortico-medullar differentiation suggesting a nephronophytosis. Genetic testing was negative. Urine oxalate levels were increased to 140 μmol/L. New genetic tests were positive for type I hyperoxaluria. The authors discuss the management of hyperoxaluria.

Prospective Assessment of Pediatrician-Diagnosed Food Protein-Induced Allergic Proctocolitis by Gross or Occult Blood

To prospectively define the incidence of food protein–induced allergic proctocolitis (FPIAP) and identify risk factors.Newborn infants (n = 903) from a single suburban, private, primary pediatrics practice in Massachusetts from April 2014 to February 2017: Gastrointestinal Microbiome and Allergic Proctocolitis cohort.Infants were recruited at their initial newborn visit and managed prospectively at routine well-child checks and sick visits for a diagnosis of FPIAP. The primary outcome was pediatrician-diagnosed FPIAP, which was then confirmed by research staff by using prespecified inclusion criteria, including documentation of gross or occult blood in the stool.The recruited cohort was predominately male (54%), White (69%), term (89%), and delivered vaginally (68%). A cumulative incidence of 17% (n = 153) of infants met inclusion criteria for a FPIAP diagnosis. The median age at symptom onset was 26 days, and the median age at FPIAP diagnosis was 35 days. Of the FPIAP cases, 41% (n = 63) had gross blood, and 37% (n = 56) had mucus with microscopic blood in their stool. The median age of symptom resolution was 123 days. Risk factors for FPIAP included a first-degree relative with food allergy (odds ratio [OR]: 1.9; 95% confidence interval [CI]: 1.2 to 2.8; P = .005), eczema (OR: 1.5; 95% CI: 1.1 to 2.2; P = .02), and household pets at birth (OR: 1.5; 95% CI: 1.01 to 2.1; P = .043). Infants initially fed both breast milk and formula were 61% less likely to develop FPIAP, compared with infants exclusively formula fed (hazard ratio [HR]: 0.39; P = .005). Infants fed both breast milk and formula at any point during the first 4 months were 56% less likely than exclusively formula-fed infants and 38% less likely than exclusively breastfed infants to develop FPIAP (HR: 0.44 [P = .005]; HR: 0.62 [P =.0497].When diagnosed clinically by community pediatricians, without confirmatory oral challenge, the prospectively defined FPIAP incidence is markedly higher than previous published estimates.FPIAP is generally considered a mild, self-limited, non–immunoglobulin E–mediated food allergy (with cow’s milk protein the most common trigger) found in otherwise healthy infants. There is a lack of validated diagnostic criteria, but elimination diet and rechallenge have been proposed. Diagnosis based solely on occult blood is controversial. This prospective observational cohort study found an exceptionally high rate of diagnosis by using the criteria applied and is possibly biased by the single-center design. This is not a criticism! It raises many important questions about infants presenting with gross or occult fecal blood. Interestingly, many of the infants had associated gagging, vomiting, food refusal, reflux, and/or irritability. Are there alternative diagnoses among this cohort? Do we need firmer diagnostic criteria? These findings underscore the need for exploring this population with gross or occult blood in the stool to better understand diagnoses, causes, and treatments. A follow-up analysis of this cohort revealed that children with the FPIAP diagnosis had a twofold risk of developing immunoglobulin E–mediated food allergy, even when accounting for atopic dermatitis as a risk (Martin VM, Virkud YV, Phadke NA, et al. Increased IgE-mediated food allergy with food protein-induced allergic proctocolitis. Pediatrics. 2020;146[3]:e20200202). This could be explained by a shared pathophysiology, or the possibility that dietary elimination was a risk factor. Because symptoms of FPIAP are often not reproduced by reexposure, there may be an unnecessary risk imposed by presumptive dietary elimination. Although, in the study, the researchers raise fascinating questions, it is important to strongly consider confirming a food trigger. Earlier milk reintroduction attempts in infants with FPIAP are thus encouraged.

Hyperoxaluria: An early diagnosis will allow a timely combined renal and liver transplantations to avoid irreversible damages to all other organs

ABSTRACT A 4-month-old patient was admitted to the emergency room for vomiting, weight gain, food refusal and hypertension. Blood gases showed a metabolic acidosis with increased anion gap. Laboratory finding revealed severe renal failure (creatinine 8 mg/dL). Renal ultrasound showed an important hyperechogenicity of the parenchyma with loss of cortico-medullar differentiation suggesting a nephronophytosis. Genetic testing was negative. Urine oxalate levels were increased to 140 μmol/L. New genetic tests were positive for type I hyperoxaluria. The authors discuss the management of hyperoxaluria.

Epizootic situation with infectious and invasive diseases in fishery of LLC “Nikolaev RMS”

Most fish farms in their economic activities for the reproduction and cultivation of fish rely on the use of a set of intensification measures, but, despite them, the spread of infectious and invasive diseases and the deterioration of the epizootic condition does not stop. Fish farms are most exposed to pathogenic effects, as they specialize in raising young fish, which is more susceptible to this type of disease. During the growing season, we conducted hydrobiological and hydrochemical studies, analyzed the epizootic state of the farm, and identified the intensity of the spread of invasive fish diseases in summer and autumn. Because invasive diseases complicate the process of reproduction and rearing of fish, which primarily leads to refusal of food, reducing the intensity of its growth, the death of a large number of aquatic organisms, which causes significant economic losses in the production process. The main purpose of the work was: identifying pathogens of infectious and parasitic diseases to identify them; establishing the intensity of infection; selection of methods of fish treatment and disease prevention in the carp farm of Mykolayivska RMS LLC and Babin-Ryba fish farm. Studies have shown that a significant proportion of fish was affected by pathogens of the class Sestoidea (cestodes): Khawia sinensis (caviosis), Caryophyllosis (karyophilosis) in all age groups, Dyplostomums pathaceum (diplostomosis), Trichodina domerguei forma acdose and three others. (ligulosis), Lernaeosis (Lerniosis), Bothriocephalus acheloignati (botryocephalus). To control the incidence of fish used cestozol, which contains 70 % niclosamide and 30 % levamisole, which helped to overcome the source of infection and curb the incidence. To prevent the occurrence of such phenomena in the future economy, it is recommended to strictly follow the veterinary and sanitary rules and regulations provided by the technological processes of reproduction and cultivation of fish.

Do children who exhibit food selectivity prefer to save the best (bite) for last?

AbstractPreference for patterns of outcomes that improve over time is termed negative time preference, in economics. In lay terms, this concept equates to “saving the best for last.” Generally, adults tend to prefer to postpone their more preferred outcomes when options are presented as a sequence of events. Event sequencing seems particularly relevant for children who exhibit food refusal or selectivity. Preference for the sequencing of bites when an array involved preferred and relatively non‐preferred foods was evaluated. Participants experienced pre‐programed bite sequences that improved, worsened, or remained fixed across trials, and we assessed participants' preference for each of the bite sequences. Three of the four participants preferred bite sequences that began with a highly preferred food and either worsened or remained fixed over time, whereas one participant preferred the improving sequence of bite presentation, or in other words, one participant preferred to “save the best for last.”

Qualitative exploration of feasibility and acceptability of the modified Atkins diet therapy for children with drug resistant epilepsy in Kenya

PurposeApproximately one-third of children with epilepsy have clinical syndromes characterized by drug resistance. Modified Atkins dietary therapy (MADT) can reduce seizures and improve health outcomes for these children. This intervention is yet to be consistently offered as standard of care in sub-Saharan Africa. ObjectivesThis study aimed to assess feasibility and acceptability of MADT for children with drug-resistant epilepsy and identify enabling strategies for implementation and adherence to the MADT. MethodsThis qualitative inquiry utilized in-depth interviews with purposively selected caregivers and adolescent patients having used MADT for drug-resistant epilepsy. A qualified team consisting of a social scientist and an interviewer carried out the interviews with consenting participants. Thematic analysis was done independent of the clinicians. ResultsThis study enrolled 17 participants including 14 caregivers of children aged 1–17 years, and three adolescents. Caregivers were predominantly trained professionals living in urban areas who had attended the epilepsy clinic for at least one year. Duration of continuous MADT use ranged from two weeks to two years. Among participants who indicated that they could afford to provide the MADT, it was less costly to provide for younger children and for those living in rural areas. At the time of the study, majority of the caregivers had ceased administration of the MADT, more than half of whom reported barriers including cost of food, child refusal of foods, and inconsistent dietician support. Social support was a key enabler to successful implementation and continuation of the diet. Majority of the participants considered MADT to be an effective and acceptable intervention for management of epilepsy. ConclusionsAmong participants in this focused Kenyan group, implementation of MADT was found to be feasible particularly for younger children living in rural areas. Majority of participants evaluated MADT to be an effective and acceptable intervention for management of epilepsy. Cultural factors did not influence feasibility or acceptability of MADT in this study.

Sensory Based Feeding Intervention for Toddlers With Food Refusal: A Randomized Controlled Trial.

ObjectiveTo investigate the effect of sensory-based feeding treatment for toddlers with food refusal compared with only providing nutrition education.MethodsThirty-two toddlers with food refusal were randomly assigned to an intervention group or the control group. Toddlers in the intervention group received the sensory-based feeding intervention and the duration was for 1 hour for 5 days per week for 4 weeks, and then 1 hour, once a week for 8 weeks. Subjects in both the intervention and control groups received nutritional education once every 4 weeks for 12 weeks. The participants were evaluated at their entry into the study and 12 weeks later based on height, weight, behavior at mealtime using the Behavioral Pediatrics Feeding Assessment Scale (BPFAS), and sensory processing ability using the Infant/Toddler Sensory Profile.ResultsSixteen toddlers were included in each group. Two subjects in the intervention group and four toddlers in the control group were excluded from the final analysis. Significant improvements in child or parent subscales of the BPFAS were observed in the intervention group. In contrast, there were no significant improvements in any BPFAS scores in the control group.ConclusionSensory-based feeding intervention was effective for improving mealtime behavior in toddlers with food refusal. Therefore, a sensory-based feeding intervention could be considered as an intervention approach to address feeding disorders in toddlers.

Improving the effects of ketogenic diet therapy in children with drug-resistant epilepsy

PurposeTo evaluate the retention rate, efficacy, and safety of ketogenic diet therapy for drug-resistant epilepsy in children and compare the results with those of a previous cohort at our institution. MethodsA total of 634 children with drug-resistant epilepsy were included in this retrospective study. Patients were categorized into two groups. The previous cohort was included as a control group and included 317 children assessed between 2004 and 2011, whereas the current group included 317 children assessed between 2015 and 2019. The control group was provided care as usual, and the current group additionally adopted the goal and long-term management strategy. Outcomes were measured with respect to retention rate, seizure reduction, and adverse reaction. ResultsPatient demographics were consistent between both cohorts. Compared to the past ten years, the retention rate significantly increased over time (3 months: 62.8% vs. 82.0%, p <0.001; 6 months: 42.0% vs. 60.6%, p <0.001; 12 months: 24.3% vs. 34.1%, p = 0.007), and the response rate was significantly improved (3 months: 35.0% vs. 55.5%, p <0.001; 6 months: 26.2% vs. 43.2%, p <0.001; 12 months: 18.6% vs. 31.5%, p <0.001). Constipation (n = 79, 24.9%) was the most common side effect in the current cohort. Food refusal and hypoproteinaemia reduced to 3.5% and 0.9%, respectively. ConclusionGoal and long-term management is effective for ketogenic diet therapy, which significantly improved the ketogenic diet retention rate, efficacy, and incidence of adverse reactions. This strategy has promising applicability in ketogenic diet therapy. Clinical registrationChiCTR-IIR-16,008,342.

Feeding difficulties in children fed a cows' milk elimination diet.

A cross-sectional study compared feeding difficulties in children aged 2-5 years fed a cows' milk elimination diet due to food allergy with a control group on an unrestricted diet. All data were obtained online. Specific questionnaires evaluated three types of feeding difficulties: avoidant eating, picky eating and feeding problems. The median scores of feeding difficulties in the elimination diet (n 146) and control (n 109) groups were, respectively: picky eating (31 v. 27; P = 0·148), avoidant eating (3 v. 3; P = 0·508) and feeding problems (38 v. 34, P = 0·032). Picky eating was more frequent in the elimination diet (35·4 %) than in the controls (23·3 %; P = 0·042), but no difference was observed for avoidant eating (23·9 % v. 20·4 %, P = 0·508) and feeding problems (32·1 % v. 28·4 %, P = 0·541). Picky eating was associated with lower values of weight-for-age z-scores in both groups. Multivariate analyses identified associations of the three feeding difficulties with previous food refusal and/or inappetence in the elimination diet group. Current constipation and anticipatory gagging were associated with feeding difficulties in both groups. In conclusion, children on an elimination diet presented higher frequency of picky eating and higher scores of feeding problems. Picky eating was associated with lower values of weight-for-age z-scores. Food refusal and/or inappetence as clinical manifestations of food allergy were associated with feeding difficulties at the moment of the survey. Current constipation and anticipatory gagging were associated with picky eating, avoidant eating and feeding problems.

The Effect of Oral Motor Therapy on Feeding Difficulties and Eating Behaviors in Younger ASD Children

Background: A variety of feeding difficulties like aversion of food, food selectivity, complete food refusal are the most common problems reported by the Parents of ASD children. Every parent of ASD children struggles to manage their child’s feeding routine as well as undesirable mealtime behaviours, which can cause parental concern and poor family dynamics.&#x0D; Aim: 1) The aim of this study is to analyze the effect of dedicated oral motor work in children with ASD who presented with feeding difficulty. 2) To determine parental concerns related to feeding behavior shown by their child and assess whether an additional home program in parallel with oral motor work by an Occupational Therapist would provide any benefits.&#x0D; Methods: This is a pre and post study where a total number of 18 ASD children at the age of 2-4 year old were participated and selected through BPFAS, out of which 15 copies were considered to be concerned with the oral motor and feeding difficulties of the child. Therefore, 15 participants who were facing feeding difficulties with their children were recruited. Concerned Participants were further assessed by Occupational therapist with the help of ‘The com deall Oro-motor assessment scale for toddlers’.&#x0D; Results: According to The Com Deall Oral-motor assessment scale, some changes observed in the oral motor skills and When parental concern is considered via home plan including mealtime strategies with oral motor activities, the post intervention result showed decrease in Total problem score as well as in Total frequency score.&#x0D; Conclusion: The study concluded that continuous structured direct oral motor work as well as addressing parental concerns via home programs is helpful for the ASD children and gives better understanding of feeding difficulties to their parents. Also, some changes have been seen in oral motor skills through continuous practice of oral motor activities by the therapist.