Indian Academy of Pediatrics Guidelines on the Fast and Junk Foods, Sugar Sweetened Beverages, Fruit Juices, and Energy Drinks

Justification: In view of easy availability and increasing trend of consumption of fast foods and sugar sweetened beverages (fruit juicesand drinks, carbonated drinks, energy drinks) in Indian children, and their association with increasing obesity and related non-communicable diseases, there is a need to develop guidelines related to consumption of foods and drinks that have the potential toincrease this problem in children and adolescents. Objectives: To review the evidence and formulate consensus statements related toterminology, magnitude of problem and possible ill effects of junk foods, fast foods, sugar-sweetened beverages and carbonated drinks;and to formulate recommendations for limiting consumption of these foods and beverages in Indian children and adolescents. Process:A National Consultative group constituted by the Nutrition Chapter of the Indian Academy of Pediatrics (IAP), consisting of variousstakeholders in private and public sector, reviewed the literature and existing guidelines and policy regulations. Detailed review ofliterature was circulated to the members, and the Group met on 11th March 2019 at New Delhi for a day-long deliberation on framing theguidelines. The consensus statements and recommendations formulated by the Group were circulated to the participants and aconsensus document was finalized. Conclusions: The Group suggests a new acronym ‘JUNCS’ foods, to cover a wide variety ofconcepts related to unhealthy foods (Junk foods, Ultra-processed foods, Nutritionally inappropriate foods, Caffeinated/colored/carbonated foods/beverages, and Sugar-sweetened beverages). The Group concludes that consumption of these foods and beveragesis associated with higher free sugar and energy intake; and is associated with higher body mass index (and possibly with adversecardiometabolic consequences) in children and adolescents. Intake of caffeinated drinks may be associated with cardiac and sleepdisturbances. The Group recommends avoiding consumption of the JUNCS by all children and adolescents as far as possible and limittheir consumption to not more than one serving per week. The Group recommends intake of regional and seasonal whole fruits over fruitjuices in children and adolescents, and advises no fruit juices/drinks to infants and young children (age <2 y), whereas for children aged 2-5 y and >5-18 y, their intake should be limited to 125 mL/day and 250 mL/day, respectively. The Group recommends that caffeinatedenergy drinks should not be consumed by children and adolescents. The Group supports recommendations of ban on sale of JUNCSfoods in school canteens and in near vicinity, and suggests efforts to ensure availability and affordability of healthy snacks and foods. TheGroup supports traffic light coding of food available in school canteens and recommends legal ban of screen/print/digital advertisementsof all the JUNCS foods for channels/magazines/websites/social media catering to children and adolescents. The Group further suggestscommunication, marketing and policy/taxation strategies to promote consumption of healthy foods, and limit availability and consumptionof the JUNCS foods

Vitamin D Dependent RicketsType ll : Late Onset Disease associated with Double Inlet Left Ventricle and Facial Dysmorphism.

Vitamin D dependent rickets type II is a rare autosomal recessive disorder. It is characterised by end organ resistance to 1,25 dihydroxy cholecalciferol. Patients present with early onset rickets, alopecia, severe hypocalcemia and secondary hyperparathyroidism. We report a 7 year old girl who presented with this disorder in association with congenital cyanotic heart disease and dysmorphic facies. Such an association has not been reported in literature.

Esophageal Diverticulum Secondary to Impacted Foreign Body.

We report a two year old child who developed a large esophageal diverticulum over a period of ten months following ingestion of a multispiked leaf of Quercus semicarpipholia.Though the endoscopic removal of foreign body was successful, it did not relieve the symptoms and patient required surgical resection of the diverticulum. Patient is asymptomatic after 4 months of follow up.

Post- Intercostal Intubation Chylothorax.

Chylothorax is a rare condition in childhood . It usually occurs as a post operative complication following cardiac surgery for heart diseases . we report a 16 months old girl with atrial septal defect and severe pulmonary stenosis, hospitalised for empyema and who developed chylothorax following intercostal drainage, an entity which has never been reported.

Congenital varicella syndrome/ vericella zoster virus (VZV) fetopathy.

An 18 hour old female newborn born to a 3rd gravida HIV-ve mother, presented with a large erythematous patch of skin on right forehead and hazy right eye since birth.There was history of chicken pox in mother during fourteenth week of pregnancy.

Plasmodium vivax malaria presenting with severe thrombocytopenia, cerebral complications and hydrocephalus.

Two cases of a one and 4 year old child of plasmodium vivax malaria are reported in association with CNS complications. Both presented with encephalopathy and seizures. One had severe thrombocytopenia, massive intracranial bleed and hydrocephalus requiring shunt surgery while the other had gastrointestinal manifestations, encephalopathy and hydrocephalus. Both responded to quinine but are left with sequelae.