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.

Rapid resumption of interrupted search is independent of age-related improvements in visual search.

In this study, 7-19-year-olds performed an interrupted visual search task in two experiments. Our question was whether the tendency to respond within 500ms after a second glimpse of a display (the rapid resumption effect [Psychological Science, 16 (2005) 684-688]) would increase with age in the same way as overall search efficiency. The results indicated no correlation of rapid resumption with search speed either across age groups (7, 9, 11, and 19years) or at the level of individual participants. Moreover, relocating the target randomly between looks reduced the rate of rapid resumption in a very similar way at each age. These results imply that implicit perceptual prediction during search is invariant across this age range and is distinct from other critical processes such as feature integration and control over spatial attention.

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.

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.

Change detection in naturalistic pictures among children with autism.

Persons with autism often show strong reactions to changes in the environment, suggesting that they may detect changes more efficiently than typically developing (TD) persons. However, Fletcher-Watson et al. (Br J Psychol 97:537-554, 2006) reported no differences between adults with autism and TD adults with a change-detection task. In this study, we also found no initial differences in change-detection between children with autism and NVMA-matched TD children, although differences emerged when detection failures were related to the developmental level of the participants. Whereas detection failures decreased with increasing developmental level for TD children, detection failures remained constant over the same developmental range for children with autism, pointing to an atypical developmental trajectory for change-detection among children with autism.