Use of cyproheptadine in young children with feeding difficulties and poor growth in a pediatric feeding program.

OBJECTIVE: The aim of this study was to assess the efficacy and safety of cyproheptadine (CY) use in infants and young children with poor growth treated at our multidisciplinary pediatric feeding program, and to describe changes in their weight and feeding behaviors. METHODS: A retrospective chart review of children treated with CY from January 2007 to July 2011 was performed. Demographic data, medical diagnosis, adverse effects of the drug, and changes in mealtime behaviors were extracted from the patients' medical records. For each patient who received the CY, weight-for-age z scores (WtZ) were calculated before and during treatment. Repeated-measures mixed model was used to analyze the pattern of change in WtZ over time and between groups. Differences in mean WtZ were tested between patients regularly receiving CY and a naturally conceived comparison group. RESULTS: Of the 127 patients in treatment owing to poor weight gain who received the CY, 82 took the medication regularly as prescribed in combination with our interventional program. For these patients, the majority of the parents (96%) reported a positive change in mealtime and feeding behaviors. A significant improvement in mean WtZ was observed after starting CY when compared with the WtZ before treatment for those patients regularly receiving the medication. This effect was independent of patients' age and/or presence of an underline medical problem. No significant differences in mean WtZ were observed over time within the comparison group. CONCLUSIONS: In our experience, the use of CY in combination with a specialized multidisciplinary interventional program is a safe and effective therapy in infants and young children with low appetite and poor growth.

Elevated circulating acylated and total ghrelin concentrations along with reduced appetite scores in infants with failure to thrive.

Failure to thrive (FTT) is a term used to describe inadequate growth in infants. The immediate cause is undernutrition. Ghrelin is a potent orexigenic hormone that induces a positive energy balance and enhances appetite. There is no information regarding the possible role of ghrelin in infants with FTT. The aim of this study was 2-fold: 1) to examine circulating ghrelin levels in FTT infants, compared with those of normally growing infants; and 2) to evaluate appetitive behaviors in the two groups. Plasma acylated and total ghrelin concentrations were measured in nine FTT and five normally growing infants (age range, 9-18 mo). Appetite was assessed using three novel appetite measures. Both acylated and total ghrelin levels were significantly elevated in FTT infants compared with controls (p = 0.03 or less). Infants with FTT scored significantly lower than control infants on all appetite measures (p = 0.002 or less). Ghrelin levels were inversely related to appetite, weight velocity, weight/length z-scores, and weight z-score. These findings provide the first evidence that infants with FTT have higher circulating ghrelin concentrations but paradoxically lower appetite scores. Increased ghrelin secretion may reflect an adaptive mechanism attempting to increase appetite and preserve energy balance in response to poor nutritional state.

Making sense of client data: clinical experience and confirmationism revisited.

The purpose of this study was to examine if the order in which case file material is presented to clinicians and length of clinical experience affect clinical judgment. Using think-aloud procedures, 36 clinicians (trainees and veterans) diagnosed the case files of a middle-aged hospital outpatient. In one version, a neutral but vivid datum was placed near the start; in the second version it was placed toward the end. Protocols generated were coded on the dependent variables, confirmation and disconfirmation of earlier inferences, and dispositional and situational inferences. MANOVA results indicate that there is an interactive order-by-experience effect on proportion of confirmatory inferences articulated by participants. Other analyses indicate that order of information presentation but not level of practitioner experience is related to the variance in the proportion of contextual and dispositional inferences articulated by participants. Implications for praxis and for training programs are examined.

The Montreal Children's Hospital Feeding Scale: A brief bilingual screening tool for identifying feeding problems.

OBJECTIVE: To establish the psychometric characteristics of a newly developed, brief bilingual 14-item parent report tool (The Montreal Children's Hospital Feeding Scale [MCH-Feeding Scale]) designed to identify feeding problems in children six months to six years of age. METHODS: To establish construct validity, 198 mothers of children visiting community paediatrician's offices (normative sample) and 174 mothers of children referred to a feeding clinic (clinical sample) completed the scale. Test-retest reliability was obtained by the re-administration of the MCH-Feeding Scale to 25 children in each sample. RESULTS: Excellent construct validity was confirmed when the mean [± SD] scores of the normative and clinical samples were compared (32.65±12.73 versus 60.48±13.04, respectively; P<0.01). Test-retest reliabilities were high for both groups (normative r=0.845, clinical r=0.92). CONCLUSION: The MCH-Feeding Scale can be used by paediatricians and other health care professionals for quick identification of feeding problems.