Weaning Children Research Articles

Nutritional care practices for children from 6 to 24 months old by Cham ethnic mothers

Background: This study aims to explore the nutritional care practices for children from 6 to 24 months old by Cham ethnic mothers in Tan Chau town, An Giang province in 2018. Methods: A cross-sectional study was conducted on Cham ethnic children aged from 6 to 24 months and their mothers living in Tan Chau town, An Giang province. Results: The rate of mothers practicing proper and sufficient prenatal care during pregnancy is 74.4%; the rate of mothers engaging in lighter work than before pregnancy is 64.2%; the rate of mothers eating more than before pregnancy is 72.2%; the rate of mothers taking iron supplements during pregnancy is high at 85%. Practices regarding the timing of weaning children are not good, with 36.8% of mothers weaning children at the wrong time. Practices for feeding children supplementary foods are relatively good: 90.7% of mothers feed their children at the right time, however, the rate of mothers providing children with a complete range of food groups is only 23.0%. Maternal care practices for sick children have many shortcomings, with 81.7% of mothers feeding children incorrectly when they have diarrhea, and only 38.4% of children receiving oral rehydration solution (ORS) when they have diarrhea. Personal hygiene practices of the mother and child care are not good, with 24.3% of mothers not properly performing hand hygiene for themselves and their children. Conclusions: We need to strengthen propaganda and consulting work for each group of subjects, especially the Cham ethnic people, on nutritional care practices for children from 6-24 months old.

Experiences in Tube Weaning Children with Congenital Heart Disease and Oral Feeding Aversion.

Infants and children with congenital heart disease (CHD) often require supplemental nutrition via tube feeding before and after surgery. Tube feeding may be required due to poor weight gain, inadequate oral-motor skills, and/or reduced endurance for oral feeding. Our team has described a successful approach to weaning this population (Horsley et al. (2022) Pediatr Cardiol 43:1429-1437). A subgroup of tube-fed patients with CHD who demonstrate oral feeding aversion (OA) presents unique challenges to the tube weaning process. We discuss our team's experience with tube weaning orally averse children with CHD. Of 36 patients enrolled in the Cincinnati Children's Heart Institute Cardiology Feeding Tube Wean Clinic, 11 (31%) were determined to have oral feeding aversion (OA) by a speech-language pathologist (SLP). Descriptive data comparing the OA group to the non-averse group was gathered prior to and during the wean. Both groups had the ability to tube wean successfully, although the OA group had lower median oral intake (9 vs 24%) and higher age at start of the wean (9 vs 4months). Those with OA also had a longer median duration of wean in days (17 vs 12days) and higher likelihood of return to tube feeds within six-month post-wean (22 vs 0%). Additionally, the OA group had a higher percentage of genetic syndromes (36 vs 16%), although this was not found to be statistically significant in this study. Children with OA present with unique challenges for tube weaning. The results of this study show that weaning children with CHD and OA is possible with a multidisciplinary team who is knowledgeable about this population.

Knowledge and Practices of Mothers’ regarding Weaning of Children and their Relation with Socioeconomic Variables in Aseer Region, Saudi Arabia

Background: Weaning refers to transitioning an infant’s diet from breast milk or formula to other foods and fluids. When the infant stops receiving breast milk, it is considered fully weaned. Aims: To assess the knowledge, and practices of mothers on child weaning in the Aseer region. Methods: A cross-sectional descriptive study was conducted among 189 mothers in Aseer Region, using a self-administered online questionnaire. Results: Nearly two-thirds of the participants were aware of the terms: weaning, diet, or complementary food (65.1%). Most of the participants (87.3%) knew the nutritional requirements for weaning their infants. There was a non-significant relationship between knowledge of mothers and their sociodemographic characteristics (e.g., their level of education, and socioeconomic condition). More than two-thirds of theparticipants (71.4%) preferred breastfeeding their children associated with semi-solid food during the 6– 9-month period. The majority of the participants (74.6%) initiated weaning with thin-consistency food. There was a significant relationship between the reason for supplementary feeding before six months and mothers’ socioeconomic condition (P <0.05). Conclusions: Mothers’ knowledge and practices were good. There were no significant relationships between mothers’ knowledge level with weaning and socioeconomic characteristics. There was a significant relationship between the reason for supplementary feeding before six months and the socioeconomic condition. Keywords: Knowledge, practice, mothers, weaning, Aseer region, Saudi Arabia.

Breastfeeding and Weaning of Children: Identifying the Practice-relevant Issues in an Urban Area of Bangladesh

The initial six months of exclusive breastfeeding, followed by appropriate complementary feeding, are critical forchildren's optimal growth and development. Since the 1980s, numerous organizations in Bangladesh have beenpromoting breast feeding, yet age-old practices have not changed significantly. Still, approximately half of children inBangladesh are not breastfed exclusively for six months and do not receive adequate complementary food. This studysought to identify the barriers and facilitators to implementing proper Infant and Young Child Feeding (IYCF)practices. A cross-sectional descriptive study was conducted at the Department of Pediatrics at Bangabandhu SheikhMujib Medical College, Faridpur, from February to June 2021. This study included sixty-six mothers with infantsaged six to twenty-four months. Face-to-face in-depth interviews were used to collect qualitative data regarding thebarriers and facilitators. Transcripts of interviews were translated, transcribed, and examined to determine the primaryfactors. The most prevalent factor was a lack of knowledge and experience with breastfeeding and supplementalfeeding. In addition, contradictory feeding information from various sources and a lack of social support for pregnantand childbearing mothers with limited decision-making capabilities were significant obstacles. In contrast, motherswho received guidance from healthcare professionals before and after delivery and who were educated and receivedfamily support were more likely to follow the recommended practice. Interventions should be prioritized to encouragemothers to take timely antenatal and post-natal care and nutritional counseling during their visits. Educating andempowering them with adequate support from the family and society is essential. Bangabandhu Sheikh Mujib Med. Coll. J. 2022;1(2):70-75

Causes of Suboptimal Eating Habits in Children Ages 0-5 Hospitalized at Hoima Regional Referral Hospital's Pediatric Ward

Healthy feeding habits significantly impact the well-being of individuals within communities by providing essential nutrients for growth and development. This study aimed to examine the various factors influencing inadequate feeding patterns among children under five years old admitted to Hoima Regional Referral Hospital's pediatric ward. Employing both quantitative and qualitative methods, the study highlighted key findings from interviews with respondents. Notably, a significant portion of parents (42.7%) of hospitalized children fell within the 16-30 age group. The focus on this age bracket stemmed from the critical phase of weaning children from breastfeeding, potentially impacting their immune systems—a concern highlighted by the World Health Organization (WHO) in 2008 regarding the hospitalization of under-five children due to malaria and compromised immune statuses after weaning. The study emphasized the profound impact of illness on feeding patterns, with approximately 47.2% of children experiencing frequent sickness and 47.5% undergoing changes in treatment during their hospital stay. Financial constraints were also a prevalent issue, with nearly 40% of mothers lacking funds at some point, directly affecting their ability to maintain adequate feeding practices and potentially leading to malnutrition in children under five. Overall, the study identified illness as a primary driver of poor feeding habits among hospitalized children, often resulting in loss of appetite and vomiting. Concurrently, poverty emerged as another significant contributor to inadequate feeding practices in this demographic, highlighting the multifaceted nature of challenges affecting the nutritional well-being of under-five children in the hospital setting. Keywords: Good feeding, Poor feeding patterns, Pediatric ward, Children under five, Mothers.

Prevalence of aflatoxin along processing points of locally made complementary food formulae in northern Uganda: Safety and children's exposure across seasons

Aflatoxin contamination along the processing points of locally made complementary food composite needs to be ascertained and minimized to reduce exposure to weaning children. The study established the concentrations of total aflatoxin (TAF) and aflatoxin B1 (AFB1) along the processing points of locally made malted millet sesame soybean composite (MMSSC) across season one (wet) and season two (dry) and determined children's exposure to them. A total of 363 samples were collected in 2019. TAF and AFB1 concentrations were determined quantitatively using an enzyme-linked immunosorbent assay (ELISA). Consequently, exposure of individual children was assessed as Estimated Daily Intake (EDI), (ng kg−1 bw day−1). All the samples along the processing points had detectable concentrations of TAF and AFB1 ranging from 0.578 μg kg−1 to 1.187 μg kg−1 and 0.221 μg kg−1 to 0.649 μg kg−1 respectively. Contamination was highest in raw materials; soybean (Glycine max) > sesame (Sesamum indicum), followed by stored composite, freshly prepared composite, and least in millet (Eleusine coracana). Contamination varied significantly across seasons with the wet season having higher contamination than the dry season at P = 0.05. All samples (100%) were within the European Commission (EC) acceptable maximum tolerable level for TAF and AFB1 (4 μg kg−1 and 2 μg kg−1) respectively for processed foods for general consumption. But were below the EU acceptable maximum tolerable level for TAF and AFB1 (0.4 μg kg−1 and 0.1 μg kg−1) respectively for processed baby foods cereals. However, all were within the United States- Food and Drug Authority (US-FDA) and East African Community (EAC) set maximum acceptable limit of 20 μg kg−1 for TAFs, 10 μg kg−1 and 5 μg kg−1 for TAF and AFB1 respectively. Conversely, exposure to these toxins was much higher than the Provisional Maximum Tolerable Dietary Intake (PMTDI) of 0.4 ng kg−1 bw day−1 to 1.0 ng kg−1 bw day−1. A significant difference in exposure to both toxins was observed with the weight. The age of 5 months was the most exposed. A concerted effort is needed to reduce children's exposure to MMSSC to TAF and AFB1, taking sesame and soybean as priority ingredients and proper storage based on season to control contamination.

Hak Istri untuk Menolak Dipoligami: Musyawarah dalam Rumah Tangga Perspektif Al-Baqarah (2): 233

The Universal Declaration of Human Rights (UDHR) equalizes male and female position includes of marriage life as it is mentioned in subsection 16 (1). That subsection is also taken by the Government of Indonesia as thebase of Law No. 23 2004 which contains of the Domestic Violence Abolishment (UU KDRT) to protect the women (wife) from the violences (phisically, psychologically, and sexually) which is committed by men (husbands). While in Islam both Sunnis and Syi’i scholars permit the polygamy according to an-Nisâ’ (4): 3. Wahbah az-Zuḥailî argued that the husband is legalized doing polygamy by two conditions, they are: the fairness and ability of providing for wifes by the husband. These two conditions absolutely closes the wife’s right to reject the polygamy. Though the reality are found many wifes are hurted psychologically caused by husbands who practice the polygamy. Therefore, this article discusses specifically the content of al-Baqarah (2): 233 and its implications for the wife's right to reject the polygamy. The verse “fa in arâdâ fiṣâlan ‘an tarâḍin minhumâ wa tasyâwurin fa lâ junâḥa ‘alaihimâ” is not only turns out the weaning matter, but also to other matters in the household, including polygamy. In other words, deliberations and mutual relationships between husband and wife is not limited by the issue of weaning children only, but also concerning other issues such as polygamy, where in the deliberations the wife has the right to accept or reject the wishes of her husband to do polygamy.

Mothers' experiences and perceptions of their child's weaning process from tube feeding within a multidisciplinary Paediatric Feeding Program.

Previous studies have described the negative impact that tube feeding of children with complex chronic diseases has on the caregivers' emotions, relationships and daily life. It is unclear whether these negative experiences persist or change during and after the weaning process. We sought to explore mothers' experiences and perceptions of their child being weaned off tube feeding within a Paediatric Feeding Program (PFP). We conducted a qualitative study using semi-structured interviews with mothers whose children <4 years old had experienced feeding tube weaning within an outpatient, family-centred, telemedicine-supported PFP. The transcripts were analyzed using thematic analysis. We conducted 9 interviews with mothers of children (n = 10) in the PFP at which point data saturation was achieved. Three main themes emerged: a) the initial emotional toll on mothers stemming from fear of perceived adverse consequences of decreasing tube feeds and uncertainty surrounding efficacy of weaning; b) achievement of weaning via a family-centered approach through gaining trust, close contact, and collaboration with the team; and c) attainment of mothers' expectations of family life through transformed relationships and social activities. A positive evolution of emotions was observed, attributable to the support of the PFP. These experiences suggest that our outpatient weaning program had a positive impact on the stress, fear, and relational challenges that mothers reported before and during initial tube weaning. These findings highlight potential areas of discussion with families at multiple stages of the child's tube feeding experience, to help normalize emotions for families and support coping strategies.

Using the TIDieR checklist to describe the intervention of the Sedation and Weaning in Children (SANDWICH) trial.

Published reports of complex interventions in randomized controlled trials often lack sufficient detail to allow trial replication and adoption into practice. The aim of this paper is to describe our experience of using the Template for Intervention Description and Replication (TIDieR) checklist in reporting a recent trial of sedation and ventilation weaning in critically ill children (the Sedation and Weaning in Children [SANDWICH] trial). The TIDieR 12-point checklist has been used to detail and describe the specific SANDWICH trial intervention and methods of implementation. Overall, we found the checklist a useful tool to direct and ensure consistency of reporting of our complex intervention used in a multi-centre clinical trial. We experienced some minor limitations in classifying training materials and delivery mode into one item because of the overlapping nature of this component. Using the TIDieR checklist to report complex interventions tested in trials provides a structured, systematic way of describing necessary detail. This allows clinicians to understand the theory behind the intervention, how it should be delivered, and the resources required. The SANDWICH intervention had a significant beneficial effect on reducing time on ventilation for children. The detailed description of the team-based intervention will aid replication, implementation and monitoring of fidelity in other paediatric intensive care units.

NUTRITIONAL VALUE AND SENSORY DESCRIPTION OF "ATADJON BASSAMOIS", A TRADITIONAL INFANTILE PORRIDGE BASED ON TIGERNUT (CYPERUS ESCULENTUS, L.)

Child malnutrition is still a public health problem in Côte d'Ivoire, mainly due to poor feeding practice linked to the low nutritional value of the staple foods used for child nutrition. However, the introduction of tigernut, proteins and lipids rich tuber, in the dietary habits of these children could constitute an interesting nutritional alternative to solve this problem. The objective of this work was to valorize the tigernut-based porridges for their use as complementary food in the diet of weaning children. To this end, physicochemical and organoleptic characteristics of four formulations AB1, AB4, RB2 and SB3 were studied. The atadjon formulations, especially AB1, presented the highest density in energy (95.70 Kcal/100g), protein (5.37 %), lipids (3.8 %) and the lowest contents in anti-nutrients with 2.17% in fiber, 36.6% in oxalates, 65.54% in tannin and 0% in phytates, contrary to the rice (RB2) and tigernut (SB3) control porridges. In addition, the atadjon formulations AB4 and AB1 were preferred to the control because of their sweet taste, tigernut flavor, brown color and flowability according to PCA analysis. Thus, this study indicates that these traditionally prepared porridges could be suitable for children receiving an average level of breastfeeding and three meals per day.

Stable isotope analysis of human bone from Ganj Dareh, Iran, ca. 10,100 calBP.

We report here on stable carbon, nitrogen, and sulfur isotope values from bone collagen of human (n = 20) and faunal (n = 11) remains from the Early Neolithic site of Ganj Dareh, Iran, dating to ca. 10,100 cal. BP. Our focus explores how isotope values of human bone vary by age and sex, and evaluates dietary practices at this site. It also provides a baseline for future studies of subsistence in the early Holocene Central Zagros Mountains, from the site with the first evidence for human ovicaprid management in the Near East. Human remains include individuals of all age groups for dietary reconstruction, as well two Ottoman intrusive burials for temporal and cultural comparison. All analyzed individuals exhibited δ13C and δ15N values consistent with a diet based heavily on C3 terrestrial sources. There is no statistically significant difference between the isotopic compositions of the two sexes, though males appear to show larger variations compared to females. Interesting patterns in the isotopic compositions of the subadults suggested weaning children may be fed with supplements with distinctive δ13C values. Significant difference in sulfur isotope values between humans and fauna could be the earliest evidence of transhumance and could identify one older adult male as a possible transhumant shepherd. Both Ottoman individuals had distinctively different δ13C, δ15N, and δ34S values compared to the Neolithic individuals. This is the first large scale analysis of human stable isotopes from the eastern end of the early Holocene Fertile Crescent. It provides a baseline for future intersite exploration of stable isotopes and insight into the lifeways, health, and processes of neolithisation associated with the origins of goat domestication at Ganj Dareh and the surrounding Central Zagros.

Factors associated with success of weaning children from prolonged enteral nutrition

Rationale: Weaning children from prolonged enteral nutrition (EN) is a challenge for both parents and healthcare providers. To date, no consensus exists on the best practice of weaning from EN, and data on predictive factors of success or failure are scarce. The aims of our study were to assess the efficacy of a weaning program, and to identify factors associated with success and failure.

Long-term efficacy of clinical hunger provocation to wean feeding tube dependent children.

The incidence of tube feeding dependency seems to increase worldwide, and these children may remain on prolonged tube feeding for many months to years. The multidisciplinary clinical hunger provocation (CHP) program is an intensive inpatient intervention of usually 2-3 weeks, aimed at weaning children from tube feeding. CHP has been proven highly effective on the short term (80-86%), particularly when applied before the age of two years but long-term data are lacking. The aims of our study were to determine the long-term efficacy of the CHP program and factors associated with success or failure and to assess anthropometrics, feeding behavior, and medical outcomes at long-term follow-up. All tube-dependent children who underwent CHP at a tertiary hospital in Amsterdam, the Netherlands, between 2001 and 2014, and had a minimum follow-up of 12-months in 2015, were eligible to participate in this retrospective cohort study. During the CHP program, tube feeding is ceased stepwise to create appetite, according to a strict protocol. The program was defined successful if patients achieved oral intake and could be fully weaned from tube feeding following the CHP program. Acute malnourishment was defined as weight for height <2 SD or loss of >1 SD within 3 months, chronic malnourishment as height for age <2 SD and both acute and chronic malnourishment as both a height for age and weight for height <2 SD. Long-term efficacy (tube free at varying follow-up periods), anthropometrics (height for age, weight for height), feeding behavior and medical outcomes were assessed by a structured cross-sectional parental interview. In total, 57 patients were admitted to the CHP program. Fifty-two patients could be contacted of whom 42 participated in the study (response rate 81%) with a median age at admittance of 19 (IQR 13-22) months (62% female). The program was initially successful in 36/42 (86% (Bca CI 95% 75.0-95.2)) patients. A younger age upon initiation of tube feeding was negatively correlated with success (p 0.016). At follow-up, a median period of 67.0 (IQR 37.0-101.5) months after discharge, long-term efficacy was 32/41 (78% (Bca CI 95% 64.1-90.0)) (1 missing data). Patients with a successful CHP had beneficial outcomes compared to those with an unsuccessful CHP, showing less selective eating behavior (p 0.025), nocturnal feeding (p 0.044), forced feeding (p 0.044) and hospital admissions (p 0.028). However, 44% of successfully weaned patients fulfilled the criteria for malnourishment at long-term follow-up (13% acute, 22% chronic, and 9% both acute and chronic (compared to 22% at admittance: 13% acute, 6% chronic, and 3% both)). 59.4% of successfully weaned patients showed signs of developmental delays or were diagnosed with new medical diagnoses (43.8%) at long-term follow-up. The multidisciplinary CHP is a highly effective short-term (86%) and long-term (78%) intervention to wean young children from tube feeding, with beneficial feeding outcomes. However, at long-term follow-up, many successfully weaned patients were malnourished, showed signs of developmental delay, and were diagnosed with new medical diagnoses. For these reasons, patients should be monitored carefully during and after tube weaning, also after successful CHP. Tube dependency might be an early expression of medical diagnoses.

Exploring cultural beliefs and practices associated with weaning of children aged 0-12 months by mothers attending services at Maternal Child Health Clinic Kalisizo Hospital, Uganda.

IntroductionDespite the fact that mothers know the exact age to wean their infants, majority of the mothers do not practice exclusive breastfeeding due to cultural beliefs and practices. The purpose of the study was to explore cultural beliefs and practices associated with weaning children at the Maternal Child Health Clinic Kalisizo Hospital.MethodsThis was a simple qualitative study. Seven in-depth-interviews were conducted among 7 mothers of children within the ages 0-12 months attending post-natal care services using self-generated semi-structured key informant's guide. This took place at the Maternal Child Health Clinic Kalisizo Hospital. Purposive sampling method was used to select mothers for the study. Three themes were generated namely: identification of the different cultural beliefs and practices associated with weaning, how the different cultural beliefs are practiced and the impacts of these cultural beliefs and practices. Data were analysed using thematic analysis.ResultsAlthough a majority of the mothers knew the recommended age to wean their infants, they did not ignore the ill-informed cultural beliefs, taboos and practices from their elders such as peer pressure, advice and counselling from mother-in laws and teachings from older women who are seen as role models.ConclusionAdherence to cultural beliefs, taboos and practices, have a powerful influence on weaning, hence hindering exclusive breast feeding.

Development and Sensory Shelf-Life Testing of KOKO Plus: A Food Supplement for Improving the Nutritional Profiles of Traditional Complementary Foods.

Providing nutritionally adequate complementary foods is essential in preventing malnutrition in young infants. Koko made from fermented corn dough constitutes the most common complementary food in Ghana. However, these do not meet the nutrient requirements. To develop and test the acceptability and shelf-life of an energy-dense complementary food supplement for improving the nutritional profile of traditional complementary foods. Surveys of families in urban and rural communities and stakeholder engagements with health professionals were done to identify the most predominant traditional complementary foods and young infants' feeding practices. A food supplement, KOKO Plus, that would improve the nutritional profile of koko and other complementary foods needed to be developed. Linear programming was used in ingredient formulations for the food supplement based on locally available foods. The acceptability of the food supplement, KOKO Plus, in koko and soup was assessed using 14 trained assessors in a 2 × 2 crossover design. Shelf-life of the product was estimated using the difference in control sensory test method at different storage temperatures (24°C, 34°C, and 44°C). Koko was the most predominant complementary food in many homes. The KOKO Plus food supplement improved the nutritional profile of koko to satisfy the nutrient intake requirements of young infants as recommended by World Health Organization. KOKO Plus was microbiologically safe, with estimated shelf-life of more than 12 months. The development of KOKO Plus as a food supplement provides a practical solution to improve the nutritional status of weaning children in Ghana.

Weaning of Children With Burn Injury by Noninvasive Ventilation: A Clinical Experience.

The aim of this study was to report the respiratory management of a cohort of infants admitted to a Pediatric Intensive Care Unit (PICU) over a 7-year period due to severe burn injury and the potential benefits of noninvasive ventilation (NIV). A retrospective review of all pediatric patients admitted to PICU between 2009 and 2016 was conducted. From 2009 to 2016, 118 infants and children with burn injury were admitted to our institution (median age 16 months [IQR = 12.2-20]); 51.7% of them had face burns, 37.3% underwent tracheal intubation, and 30.5% had a PICU stay greater than 7 days. Ventilated patients had a longer PICU stay (13 days [IQR = 8-26] vs 4.5 days [IQR = 2-13]). Both ventilation requirement and TBSA% correlated with PICU stay (r = .955, p < .0001 and r = .335, p = .002, respectively), while ventilation was best related in those >1 week (r = .964, p < .0001 for ventilation, and r = -.079, p = .680, for TBSA%). NIV was introduced in 10 patients, with the aim of shorten the invasive ventilation requirement. As evidenced in our work, mechanical ventilation is frequently needed in burned children admitted to PICU and it is one of the main factors influencing PICU length of stay. No difference was found in terms of PICU length of stay and invasive mechanical ventilation time between children who underwent NIV and children who did not, despite children who underwent NIV had a larger burn surface. NIV can possibly shorten the total invasive ventilation time and related complications.

Definitions and Clinical Guidance on the Enteral Dependence Component of the Avoidant/Restrictive Food Intake Disorder Diagnostic Criteria in Children.

The aim of the current article is to offer definitive guidance on weaning children who are reliant on nasogastric/gastrostomy feeding tubes. To date, no internationally recognized definitions or principles for interventions exist, and clinics have been reliant on creating their own unique intervention criteria. To achieve the aim, 2 goals are set out within the current article. The first goal was to definitively define the process of tube weaning. To achieve this, both tube dependency and oral eating also required definitions. It is necessary for these 2 additional definitions to fully understand the process of tube weaning and the transition that the child is making within these clinical interventions. The second goal of this article was to propose a set of minimum measurement criteria within a tube weaning protocol so that different clinical practices and perspectives may be measured accurately. This would then allow outcomes from different clinical services to be compared for efficacy. The culmination of this article is a set of 5 core principles that should govern clinics that adhere to the auspices of evidence-based practice. These principles, if adopted, will provide the basis of a set of internationally recognized criteria within this field of pediatric gastroenterology.

Spontaneous Breathing Trial: A Reliable Method for Weaning in Children

Introduction Mechanical ventilation may be lifesaving intervention,It can be associated with complications,Thus,successful weaning is constitutive.One of the factors which is important in successful weaning is method of weaning. It is shown that weaning is conducted successfully by using Spontaneous Breathing Trial (SBT) through T-piece and pressure support (PS) ventilation.But few studies have not accepted it.In this study,we evaluated the role of SBT in extubation of patients in pediatric intensive care. Materials and Methods In a cross sectional and analytical study, three hundred sixty patients with adequate gas exchange (indicated by PaO2 higher than 60 mm/Hg while FIO2 of 0.40 or less (or PaO2 ∕ FIO2ratio> 300) were enrolled. Patients underwent a 2-hours trial of spontaneous breathing with pressure support ventilation.They were monitored during the test for 2 hours and were classified as failing the test if at any time in the 2-hours period ,there was tachypnea , excessive work of breathing,Tachycardia and SPO2<90%.Extubation failure was defind as needing reintubation within 72 hours of extubation. Results 240 patients(66%) of 360 patients successfully underwent SBT and were immediately extubated.In 120 patients(33%) ,the trial of spontaneous breathing was stopped.(trial failure;33% vs. 66% P=0.04). Of the 240 patients with successful SBT,29 patients were re-intubated (extubation failure) and 211 patients had successful extubation.(12% vs. 88% p=o.oo2).For patients experienced successful extubation ,the mortality rate was 5% While the rate of mortality was 27% in patients with needing re-intubation.(5% vs. 27% p= o.oo3) Conclusion The spontaneous breathing trial with pressure support prior to elective extubation may predict successful extubation in ventilated children.

Exposure of children 4 to 6 months of age to aflatoxin in Kisumu County, Kenya

Contamination of foods by aflatoxins is a global health problem in both developed and developing countries. Exposure to the toxin s is associated with a range of effects on health including stunting in children. Commodities at high risk of aflatoxin contamination include cereals, legumes, milk, fish and meats. Children are more vulnerable to effects of aflatoxin exposure compared to adults. Being genotoxic , levels of aflatoxins in foods should be kept as low as possible, given that there is no known threshold at which they may pose a health risk . This study investigated the potential exposure of young children to aflatoxin contamination in Kisumu County, Kenya. Kisumu County may have the potential for low to high levels of aflatoxin contamination due to prevailing weather conditions as well as reliance on maize, sorghum, cassava and rice as the main staple foods, groundnuts as snack and omena ( Rastrienobola argentea ) and milk as cheap source s of protein. These foods are also used as weaning foods in the County. Samples of omena , rice, groundnuts, cassava, maize, and sorghum were collected from Kibuye wholesale market , Kibuye open air market , Ahero market , Oile market and Mamboleo market in Kisumu County using a combination of cluster and systematic sampling. Processed cow’s milk samples were collected from supermarkets and raw cow’s milk samples from 3 market milk bazaars in the County . Analysis of solid foods was done using HELICA Total Aflatoxin Assay, intended for quantitative detection of aflatoxin B 1 , B 2 , G 1 and G 2 . Milk sampling was done using the European model outlined in the Codex Alimentarius. Aflatoxin M 1 levels in milk were analyzed using HELICA Aflatoxin M 1 Assay. Aflatoxin levels in the foods ranged from 0 to 34.5 ppb aflatoxin B 1 , 0.012 to 0.127 ppb aflatoxin M 1 in processed milk and 0.0002 to 0.013 ppb aflatoxin M 1 in raw milk . All the food products , except cassava, had samples with detectable aflatoxin levels. Daily aflatoxin consumption ranged from 35 ng (4.43/kgBw/day) to as high as 872 ng (110.4 ng/kgBW ). These findings indicate that weaning children in Kisumu County are potentially exposed to levels of aflatoxins above the permissible amounts , given that the food stuffs that were analyzed are the commonly used weaning food items. Its effects on their health should be assessed and efforts taken to reduce potential exposure both from the commonly suspected sources as well as from milk.

Traditional weaning foods and practices in Jabalpur district with reference to prevalence of malnutrition

Weaning is an important milestone in a baby’s life and weaning practices are strongly associated with culture of a society. In present investigation, an extensive survey was conducted on approximately 300 weaning children belonging to 12 Anganwadis (AWW) of 6 Integrated Child Development Scheme (ICDS) regions lying in Jabalpur District to identify the traditional dietary pattern of weaning children. The diets of children were deficient in calories, protein, calcium, vitamin C and b-carotene. Supplementary foods are introduced into the diet at the ages of 4 to 8 months of children. Moderate to severe category of malnutrition was observed. Identified traditional weaning foods were based on cereals, small millets and pulses. Most prevalent traditional weaning foods of Jabalpur were found to be khichadi, dalia, roti (wheat/maize/kutki), sattu, pej (kodo/maize/kutki), panjiri, sewai, dal (lentil/arhar/batari), chawal (kodo/kutki/paddy), kudai bhat, latchaka (kodo/maize) and rejgeera ladoo.