ALLERGIC PROCTOCOLITIS IN INFANTS: analysis of the evolution of the nutritional status / Proctocolite alérgica em lactentes: análise da evolução do estado nutricional

ABSTRACT Background Allergic proctocolitis is a disease that affects infants in the first months. The change in feed is the primary factor for clinical improvement and maintenance of the nutritional status of the infant. Objective Study the anthropometric evolution of infants with allergic proctocolitis at diagnosis and 1 to 6 months after nutritional intervention. Methods A retrospective cohort of infants with allergic proctocolitis diagnosis followed at the Pediatric Gastroenterology Institute of São Paulo (IGASTROPED), Brazil. The database with clinical, therapeutic and anthropometric data was obtained from medical records of outpatient infants. The therapeutic intervention was characterized by 1) exclusive breastfeeding with maternal exclusion diet of the six allergens (EBF-MED) or 2) no breastfeeding and use of hypoallergenic formulas. Results Of the 44 infants diagnosed with allergic proctocolitis, 23 were female. The median age of the infants was 3.5 months at the time of admission and 6 months after the intervention. The main clinical complaint was hematochezia with or without other symptoms of allergic proctocolitis. No difference was shown in the infants anthropometric evaluation between the two diets. Conclusion The duration of the allergic proctocolitis did not induce worsening of the infants nutritional status. Importantly, both nutritional interventions were able to keep the infants within the growth channel and resulted in the total clinical symptoms remission. Considering the fundamental mother-child link promoted by breastfeeding, the present data highlights the beneficial role of EBF-MED on the nutritional status of infants diagnosed with allergic proctocolitis in addition to the lower cost that breastfeeding brings compared the use of hypoallergenic formulas.

RESUMO Contexto Proctocolite alérgica é uma enfermidade que afeta lactentes nos primeiros meses. A modificação na alimentação é o fator primordial para melhora do quadro e manutenção do estado nutricional do lactente. Objetivo Avaliar a evolução antropométrica de lactentes com proctocolite alérgica no momento do diagnóstico e 1 a 6 meses após a intervenção nutricional. Métodos Coorte retrospectiva de lactentes com diagnóstico de proctocolite alérgica acompanhados no Instituto de Gastroenterologia Pediátrica de São Paulo (IGASTROPED), Brasil. Os dados foram obtidos a partir dos prontuários de lactentes atendidos ambulatorialmente, coletando-se informações acerca do diagnóstico clínico, conduta terapêutica e dados antropométricos. A intervenção terapêutica foi caracterizada 1) aleitamento materno exclusivo com dieta de exclusão materna de seis alérgenos (AME-DEM) 2) fórmulas hipoalergênicas. Resultados Dos 44 lactentes diagnosticados com proctocolite alérgica, 23 eram do sexo feminino. A mediana de idade dos lactentes foi de 3,5 meses no momento da admissão e de 6 meses após a intervenção. A queixa clínica principal foi hematoquezia associada ou não a outros sintomas da proctocolite alérgica. Não houve diferença estatística na avaliação antropométrica dos lactentes em ambas as dietas. Conclusão A vigência da proctocolite alérgica não provocou agravo do estado nutricional dos lactentes e apesar de diferentes intervenções nutricionais, os lactentes se mantiveram dentro do canal de crescimento e ocasionou o desaparecimento total dos sintomas clínicos. A despeito destes resultados, destaca-se o papel benéfico do AME-DEM no processo de manutenção do estado nutricional do lactente e do vínculo mãe e filho, além do menor custo que o aleitamento materno traz comparado a utilização de fórmulas hipoalergênicas.

The effect of maternal near miss on adverse infant nutritional outcomes

OBJECTIVES: To evaluate the association between self-reported maternal near miss and adverse nutritional status in children under one year of age. METHODS: This study is a secondary analysis of a study in which women who took their children under one year of age to the national vaccine campaign were interviewed. The self-reported condition of maternal near miss used the criteria of Intensive Care Unit admission; eclampsia; blood transfusion and hysterectomy; and their potential associations with any type of nutritional disorder in children, including deficits in weight-for-age, deficits in height-for-age, obesity and breastfeeding. The rates of near miss for the country, regions and states were initially estimated. The relative risks of infant adverse nutritional status according to near miss and maternal/childbirth characteristics were estimated with their 95% CIs using bivariate and multiple analyses. RESULTS: The overall prevalence of near miss was 2.9% and was slightly higher for the Legal Amazon than for other regions. No significant associations were found with nutritional disorders in children. Only a 12% decrease in overall maternal breastfeeding was associated with near miss. Living in the countryside and child over 6 months of age increased the risk of altered nutritional status by approximately 15%, while female child gender decreased this risk by 30%. Maternal near miss was not associated with an increased risk of any alteration in infant nutritional status. CONCLUSIONS: There was no association between maternal near miss and altered nutritional status in children up to one year of age. The risk of infant adverse nutritional status was greater in women living in the countryside, for children over 6 months of age and for male gender.

Maternal mental health and nutritional status of six-month-old infants / Saúde mental materna e estado nutricional de crianças aos seis meses de vida

ABSTRACT OBJECTIVE To analyze if maternal mental health is associated with infant nutritional status at six month of age. METHODS A cross-sectional study with 228 six-month-old infants who used primary health care units of the city of Rio de Janeiro, Southeastern Brazil. Mean weight-for-length and mean weight-for-age were expressed in z-scores considering the 2006 World Health Organization reference curves. Maternal mental health was measured by the 12-item General Health Questionnaire. The following cutoff points were used: ≥ 3 for common mental disorders, ≥ 5 for more severe mental disorders, and ≥ 9 for depression. The statistical analysis employed adjusted linear regression models. RESULTS The prevalence of common mental disorders, more severe mental disorders and depression was 39.9%, 23.7%, and 8.3%, respectively. Children of women with more severe mental disorders had, on average, a weight-for-length 0.37 z-scores lower than children of women without this health harm (p = 0.026). We also observed that the weight-for-length indicator of children of depressed mothers was, on average, 0.67 z-scores lower than that of children of nondepressed women (p = 0.010). Maternal depression was associated with lower mean values of weight-for-age z-scores (p = 0.041). CONCLUSIONS Maternal mental health is positively related to the inadequacy of the nutritional status of infants at six months.

RESUMO OBJETIVO Analisar se saúde mental materna associa-se ao estado nutricional infantil no sexto mês de vida. MÉTODOS Estudo seccional com 228 crianças aos seis meses atendidas em unidades básicas de saúde do município do Rio de Janeiro. Médias de peso-para-comprimento e peso-para-idade foram expressas em escores z considerando as curvas de referência do World Health Organization 2006. A saúde mental materna foi aferida pelo General Health Questionnaire com 12 itens. Foram empregados os pontos de corte ≥ 3 para transtornos mentais comuns, ≥ 5 para transtornos mentais mais graves e ≥ 9 para depressão. Na análise estatística empregaram-se modelos de regressão linear ajustados. RESULTADOS As prevalências de transtornos mentais comuns, transtornos mentais mais graves e depressão foram de 39,9%, 23,7% e 8,3%, respectivamente. Para peso-para-comprimento, filhos de mulheres com transtornos mentais mais graves tinham, em média, 0,37 escores z mais baixos do que filhos de mulheres sem este agravo (p = 0,026). Também para o indicador peso-para-comprimento observou-se que, em relação aos filhos de mulheres não deprimidas, crianças de mães deprimidas apresentaram, em média, 0,67 escores z mais baixos (p = 0,010). Depressão materna esteve associada com valores médios mais baixos de escore z de peso-para-idade (p = 0,041). CONCLUSÕES A saúde mental materna está positivamente relacionada à inadequação do estado nutricional de crianças aos seis meses.

Household Food Insufficiency and Child Nutritional Status in Urban Slum, Dhaka, Bangladesh.

Introduction: Malnourished children are about 20% in the developing world. Food insecurity is a key risk factor for child malnutrition. Food insuffi ciency, an extreme form of household food insecurity, can aff ect physiological mechanisms that are linked to an individual’s nutritional status. Food-insuffi cient children are also more likely to have poorer health status and to experience a range of negative academic and psychosocial outcomes. Methods: We administered a cross-sectional socioeconomic survey to 354 households in research site, including a validated food insuffi ciency measurement questionnaire, and obtained anthropometric measurements from children aged 12 to 24 months. We used chi-square tests to assess the relationship between household food insuffi ciency and nutritional status of children. Results: Average age of study children was 18 months and standard deviation was (± 3.2 months). Th e status of household food insuffi ciency was 56%. Th e prevalence of underweight, stunting and wasting was 24%, 36% and 8% respectively. Th e household food insuffi ciency was signifi cantly (p<0.05) associated with underweight and stunting but not with wasting (p>0.05). Discussion: Th e study results indicate that food insuffi ciency is associated with stunting and underweight but not with wasting in urban slum of Bangladesh. We also found that child malnutrition is associated with mother’s education, father’s education, monthly family income and people per room.

Disfunción familiar como factor asociado a desnutrición crónica en niños menores de 5 años en un centro de salud de Lima - Perú, 2012 / Family dysfunction as a factor associated with chronic malnutrition in children less than 5 years in a health center in Lima - Peru, 2012

Introducción: Desnutrición infantil es un problema de salud pública. La disfunción familiar ha sido asociada a desnutrición infantil. Investigación en esta línea se ha desarrollado en algunos países latinoamericanos pero no se tiene información en Perú. El objetivo fue demostrar la asociación entre disfunción familiar y desnutrición crónica en niños menores de 5 años. Material y métodos: Estudio cuantitativo, diseño analítico transversal. Muestra: 92 niños menores de 5 años, usuarios del C.S. Surquillo (Lima) en 2012. Datos recogidos: edad, talla, peso de los niños para índices talla/edad, peso/talla, peso/edad (v. dependiente). Además funcionalidad familiar, institucionalidad del parto, grado de instrucción y ocupación de la madre (v. independiente). Cálculos realizados con nivel de confianza 95 por ciento y valor alfa 0,05. Resultados: 53,3 por ciento niños y 46,7 por ciento niñas. Parto no institucional: 4 (4,3 por ciento); 63 por ciento de las madres trabajaban y la mayoría tenía instrucción secundaria (65,22 por ciento). Funcionalidad familiar: Buena: 9,8 por ciento, disfunción leve: 55,4 por ciento, disfunción moderada: 27,2 por ciento y disfunción severa: 7,6 por ciento. La muestra se estratificó según puntuaciones Z, obteniendo que 9,8 por ciento estuviera en riesgo de talla baja y 22,8 por ciento con sobrepeso. La funcionalidad familiar estuvo asociada con los índices T/E, P/T y P/E, realizándose Chi cuadrado y simulación de Monte Carlo para variables categóricas y las pruebas de correlación de Pearson y regresión lineal para variables cuantitativas. También mostró asociación el grado de instrucción materno con los índices T/E y P/E. Institucionalidad del parto y ocupación de la madre no mostraron asociación con el estado nutricional. Conclusiones: La funcionalidad familiar y el grado de instrucción materno estuvieron asociados al estado nutricional de los niños de la muestra. Es conveniente realizar estudios de corte poblacional y con muestreo...

Introduction: Children’s malnutrition is a public health problem. Family dysfunction has been associated with children's malnutrition. Investigation in this topic has been done in some Latin-Americans countries, but in Peru there’s no information. The objective was to demonstrate association between family dysfunction and chronic malnutrition in children under five years-old. Methods: Quantitative study. Design: transversal analytic. Were enrolled 92 children under 5 years-old, users of Surquillo Health Center (Lima) in 2012. Data collected: age, length, weight of children for length/age, weight/length and weight/age index. Also were collected family functionality, institutional birth, instruction grade and mothers occupation. Analysis was done with CI: 95 per cent and 0.05 alpha value. Results: 53.3 per cent was male and 46.7 per cent female. Non institutional birth: 4.3 per cent; 63 per cent of mothers work and the majority have high school instruction (65.22 per cent). Family functionality: good 9.8 per cent, mild dysfunction 55.4 per cent, moderate dysfunction 27.2 per cent and severe dysfunction 7.6 per cent. Participants were stratified by Z punctuations, obtaining 9.8 per cent with low length risk and 22.8 per cent with overweight. Family functionality was associated with L/A, W/L and W/A index, using Chi squared and Monte Carlo simulation for categorical variables and Pearson correlation test and lineal regression test for quantitative variables. Also mothers instruction grade was associated with L/A and W/A index. Institutional birth and mother’s occupation were not associated with nutritional status. Conclusions: Family functionality and mother’s instruction grade were associated with nutritional status of children enrolled. It is convenient to do population studies and with randomized samples for to evaluate family dysfunction and its association with chronic malnutrition in children. Diffusion of these results will let to promote strategies for to...

Determinação de risco nutricional e desnutrição por antropometria em crianças e adolescentes com cirrose / Nutritional risk and malnutrition determination by anthropometry in cirrhotic children and adolescents

RACIONAL: A desnutrição é achado freqüente em adultos com cirrose, mas a prevalência de risco nutricional e de desnutrição é pouco conhecida em pacientes pediátricos. OBJETIVO: Avaliar a ocorrência de risco nutricional e desnutrição em pacientes pediátricos com cirrose atendidos regularmente no Setor de Gastroenterologia Pediátrica do Hospital de Clínicas de Porto Alegre, RS. MÉTODOS: Estudo transversal com 42 crianças e adolescentes cirróticos com idades entre 3 meses e 18 anos. O estado nutricional foi determinado por escores Z de peso para idade, estatura para idade, índice de massa corporal e percentis para a prega cutânea tricipital e circunferência muscular do braço. Consideraram-se pacientes em risco nutricional aqueles com escore <-1,28 Z, correspondente ao percentil <10, e desnutridos aqueles com escore <-2,0 Z, correspondente ao percentil <3. Segundo o critério de Child-Pugh, 22 pacientes foram classificados como A (leve intensidade), 15 como B (moderada) e 5 como C (grave). RESULTADOS: As médias e desvios-padrão dos escores Z de peso para idade, estatura para idade e índice de massa corporal foram respectivamente - 0,38 ± 1,4 DP, - 0,83 ± 1,16 DP e 0,17 ± 1,3 DP. A prega cutânea tricipital e a circunferência muscular do braço apresentaram medianas no percentil 25. Encontraram-se em risco nutricional 3/42 pacientes (peso para a idade), 8/42 (estatura para idade), 12/37 (prega cutânea tricipital), 9/37 (circunferência muscular do baço) e 2/38 (índice de massa corporal); desnutridos 6/42 (peso para a idade), 7/42 (estatura para idade), 4/37(prega cutânea tricipital) e 4/37(circunferência muscular do braço) e 3/38 (índice de massa corporal). CONCLUSÃO: Os índices antropométricos mais comprometidos foram a relação estatura para idade e a prega cutânea tricipital. Ocorreu uma prevalência de 32,4 por cento de risco nutricional determinado pela prega cutânea tricipital e 16,7 por cento de desnutrição pela relação...

BACKGROUND: The malnutrition is a frequent finding in adults with cirrhosis, but the prevalence of nutritional risk and malnutrition is little known in pediatric patients. AIM: To evaluate through anthropometry the presence of nutritional risk and malnutrition in cirrhotic pediatric patients regularly attended at the Pediatric Gastroenterology Service of "Hospital de Clínicas" of Porto Alegre, RS, Brazil. METHODS: Cross-sectional study with 42 cirrhotic children and adolescents aged between 3 months and 18 years. The nutritional evaluation was made by the determination of the weight/age, height/age, body mass index and triceps skinfold thickness and arm muscle circumference measurements. Patients considered in nutritional risk were < -1,28 Z score which corresponds to <10th percentile, and those under -2,0 Z and <3th percentile were in malnutrition status. According to Child-Pugh criteria, 22 patients were classified as A (mild severity), 15 (moderate) B and 5 C (intense). RESULTS: The mean weight/age, height/age and body mass index Z scores were, respectively, - 0,38 ± 1,4 SD, - 0,83 ± 1,16 SD and 0,17 ± 1,3 SD. Patients in nutritional risk were 3/42 (weight/age), 8/42 (height/age), 12/37 (triceps skinfold thickness), 9/37 (arm muscle circumference), 2/38 (body mass index); in malnutrition status were 6/42 (weight/age), 7/42 (height/age), 4/37 (triceps skinfold thickness) and 4/37 (arm muscle circumference) and 3/38 (body mass index). CONCLUSION: The prevalence of nutritional risk was 32.4 percent and chronic malnutrition was 16.7 percent. The index which better reflected the nutritional risk in these patients was triceps skinfold thickness. Chronic malnutrition status occurrence was greater in the height/age index.

Influence of infant-feeding practices on nutritional status of under-five children.

OBJECTIVES: To study the nutritional status of under-five children and to assess whether infant feeding practices are associated with the undernutrition in anganwari (AW) areas of urban Allahabad. METHODS: Under-five-years children and their mothers in selected four anganwari areas of urban Allahbad (UP) participated in the study. Nutritional assessment by WHO criterion (SD- classification) using summary indices of nutritional status: weight-for-age, height-for-age and weight-for-height was done. Normal test of proportions, Chi-square test for testing association of nutritional status with different characteristics and risk analysis using odds ratios with 95% confidence intervals was also done. RESULTS: Among all under five children surveyed, 36.4% underweight (< 2SD weight- for -age), 51.6% stunted (< 2SD height- for- age) and 10.6% wasted (< 2SD weight- for- height). Proportions of underweight (45.5%) and stunting (81.8%) were found maximum among children aged 13-24 months. Wasting was most prevalent (18.2%) among children aged 37-48 months. Initiation of breast-feeding after six hours of birth, deprivation from colostrum and improper complementary feeding were found significant (P< 0.05) risk factors for underweight. Wasting was not significantly associated (P>0.10) with any infant feeding practice studied. ICDS benefits received by children failed to improve the nutritional status of children. CONCLUSION: Delayed initiation of breast-feeding, deprivation from colostrum and improper weaning are significant risk factors for undernutrition among under-fives. There is need for promotion and protection of optimal infant feeding practices for improving nutritional status of children.

High prevalence of malnutrition among patients with solid non-hematological tumors as found by using skinfold and circumference measurements

CONTEXTO E OBJETIVO: Em pacientes com câncer, a desnutrição tem múltiplas causas. Medidas antropométricas de peso e estatura são o método mais utilizado para avaliação do estado nutricional. Infelizmente, esse método é limitado em pacientes com câncer, pois o peso inclui o tumor e a relação peso/estatura não leva em conta alterações específicas de tecido magro. O objetivo deste estudo é avaliar diferenças entre medidas antropométricas e de composição corporal em crianças e adolescentes com câncer. TIPO DE ESTUDO E LOCAL: Estudo de corte transversal realizado no Instituto de Oncologia Pediátrica, Universidade Federal de São Paulo — Escola Paulista de Medicina, São Paulo, Brasil. MÉTODOS: Crianças e adolescentes com câncer com idade acima de um ano foram avaliadas de março de 1998 a janeiro de 2000. Medidas antropométricas tradicionais foram coletadas no primeiro mês de tratamento oncológico (terapia de indução) por meio do escore-z de peso para estatura (P/E) nas crianças e índice de massa corpórea (IMC) nos adolescentes. A avaliação da composição corporal foi composta por medidas de prega cutânea triciptal (PCT), circunferência do braço (CB) e circunferência muscular do braço (CMB). Os dados foram analisados comparando-se as prevalências de desnutrição entre os métodos de avaliação nutricional. O teste do qui-quadrado e o grau de associação foram usados para comparar as taxas entre portadores de tumores sólidos e hematológicos. RESULTADOS: 139 pacientes foram avaliados, 127 tinham dados completos para análise. O estudo demonstrou maior percentual de déficit nos portadores de doenças sólidas não-hematológicas pelo P/E ou IMC, CB, e CMB. A análise global também sugere que a PCT (40%) e a CB (35%) demonstraram maior percentual de déficit quando comparadas ao escore-z de P/E ou IMC (19%). CONCLUSÃO: Pacientes com tumores sólidos apresentaram maior prevalência de desnutrição. As medidas de composição corporal por meio da PCT e CB detectaram mais pacientes desnutridos do que o P/E e o IMC.

Situación de salud y nutrición en la población menor de 18 años de Providencia y Santa Catalina / Health and nutrition state in younger than 18 population from Providencia and Santa Catalina

Las enfermedades transmisibles de notificación obligatoria continúan teniendo una prevalencia significativa en la comunidad. Con los resultados del estudio hecho en torno a esta problemática sepretende evaluar la situación de salud y nutrición de la población infantil de las Islas de Providencia y Santa Catalina. Metodología: durante un período de seis días se realizó una brigada de salud. Se valoraron médicamente los niños entre cero y 18 años de edad. Se clasificaron los pacientes de acuerdo con las patologías más frecuentes, con los grupos etéreos, con el estado nutricional y con la afiliación a seguridad social. Resultados: se valoraron 366 pacientes, 164 niñas y 202 niños. La infección respiratoria aguda fue la tercera causa de consulta de la población menor de cuatro años de edad. La condición de malnutrición predominante fue la de sobrepeso. Más de la mitad de la población infantil pertenece al régimen subsidiado. El consumo de frutas y verduras es deficiente. Conclusión: las estrategias en salud en la población de Providencia deben estar encaminadas hacia la disminución de la prevalencia de sobrepeso y de enfermedades transmisibles dentro de la población infantil mediante programas de atención básica.

HIV serostatus and recovery from severe childhood malnutrition. A retrospective matched case-control study

The world-wide epidemic of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) has led to an increase in the number of HIV positive children, mainly through perinatal transmission. HIV/AIDS can lead to severe childhood malnutrition (SCM) and has been noted as an increasingly common cause of secondary SCM. In this context, it is important to make assessments of the appropriateness of current approaches to treatment of severe malnutrition in HIV positive children. A retrospective matched case-control study of ten HIV positive children admitted to the Tropical Metabolism Research Unit (TMRU) was conducted. There were few differences between cases and matched controls on admission to the ward. Oral candidiasis and lower respiratory tract infections appeared to occur more frequently, and serum globulin concentrations were significantly higher among HIV positive cases when compared to their controls. Despite the fact that the differences between cases and controls appeared to be small, four cases died; there were no deaths among the controls. The duration of the maintenance phase was approximately five days longer (p = 0.024) among cases than controls but the time between the end of the maintenance phase and discharge from the ward was not significantly longer for the cases. The results of this matched case-control study suggest that there are likely to be important differences between HIV positive and negative patients with SCM that influence risk of mortality and morbidity, particularly in the maintenance phase of treatment. Prospective studies will be required in order to explore these differences and to develop better approaches to the care of HIV positive children with SCM

Desnutrición infantil: Centro de prevención y centro de tratamiento de la Fundación CONIN / Infant malnutrition: CONIN Foundation's centers for prevention and treatment

Convencidos que de nada sirve alimentar a un niño si lo devolvemos al ambiente de miseria extrema del que proviene, se crea entonces el Primer Centro Multidisciplinario de Prevención de la Desnutrición Infantil "María Alejandrina Rosa de Arenas", único en su género. Allí, a través de distintos programas, se abordan las principales causas que dan origen a la desnutrición, entre ellos podemos mencionar: Estimulación de la Lactancia Materna, Asistencia Alimentaria Complementaria, Educación Nutricional, Educación para la salud, Ropero Familiar, Alfabetización para Adultos, Jardín Maternal e Infantil, Estimulación Temprana, Talleres de Artes y Oficios para padres, Minoridad y Familia, Documentación y Legalización de la Familia, Planificación Familiar Natural y Escuela de Capacitación Agraria. Otros Centros de similares características funcionan en el Departamento de Rivadavia, Mendoza y en la República de Paraguay (fundado en 1995 desde Mendoza). Simultáneamente se fueron dando los primeros pasos para concretar la construcción del Primer Centro de Recuperación de Lactantes Desnutridos de la República Argentina. Otro pilar fundamental en la lucha contra la desnutrición es la investigación, por ello CONIN ha creado el "Centro de Investigaciones Médico-Sociales Prof. Dr. José Luis Minoprio".

Utilizaçäo de formulas lacteas no primeiro ano de vida: recomendaçäo da Sociedade Paulista de Gastroenterologia Pediatrica e Nutriçäo / Use of milk formula during the first year of life: recommendation of the \"Paulista Society of Pediatric Gastroenterology and Nutrition\" (SPGPN)

Existem alguns estudos sugerindo maior prevalência de anemia em crianças alimentadas com leite de vaca "in natura" do que naquelas alimentadas com formulas lacteas. Esta deficiencia se deve provavelmente ao menor aporte e menor biodisponibilidade do ferro no leite näo modificado, mas parece haver, também, perda sanguinea significativa quando o lactente toma leite "in natura". A prevalência de anemia ferropriva e alta em nosso meio. As Sociedades Europeia de Gastroenterologia Pediatrica e Americana de Pediatria recomendam formula modificada durante o primeiro ano de vida. Preocupados com estes aspectos, a SPGPN discutiu a materia e recomenda que as crianças cuja alimentaçäo ao seio seja possível, recebam formula adaptada como aporte durante o primeiro ano de vida