Management of infantile colic.

Although infantile colic is considered to be a self-limiting and benign condition, it is often a frustrating problem for parents and caregivers. It is a frequent source of consultation with healthcare professionals and is associated with high levels of parental stress and anxiety.(1,2) Several published reviews of the literature have explored dietary, pharmacological, complementary and behavioural therapies as options for the management of infantile colic.(1,3) Here, we assess whether these management options are supported by the literature and if there are any novel treatment options.

What are the risks and benefits to increasing dietary bone minerals and vitamin D intake in infants and small children?

Bone minerals and vitamin D are crucial for infants and small children. Human milk has little vitamin D, and supplemental vitamin D must be given to all infants either via drops or as contained in infant formula or foods. The calcium and phosphorus in human milk are adequate for infants in the first six months of life, with supplemental minerals coming from weaning foods after six months. Long-term benefits to providing bone minerals at greater levels than in human milk have not been shown. There is no evidence to support high-dose bone mineral supplementation or high-dose vitamin D supplementation in infancy, and controlled trials are needed before these can be advocated.

Niveles de 25-hidroxivitamina D en lactantes. Relación con la lactancia materna / 25-Hydroxyvitamin D levels in infants. Relation with breast-feeding

Objetivo: Determinar la prevalencia de la deficiencia subclínica de vitamina D en lactantes del área de Valencia, España (latitud 39,5° N) y su relación con la lactancia materna. Material y métodos: Se midieron los niveles séricos de calcio, fosfato, fosfatasas alcalinas, 25-hidroxivitamina D (25[OH]D) y hormona paratiroidea (PTH) intacta en 60 lactantes entre 1 y 6 meses de edad, nacidos a término (media de edad 3,9 meses), sin enfermedad ósea, gastrointestinal o renal (33 alimentados con lactancia materna exclusiva y 27 con lactancia artificial). Se recogieron datos de suplementación con vitamina D y de tiempo semanal de exposición solar. Resultados: Todos los lactantes tenían niveles normales de calcio, fosfato y PTH. En cinco de ellos (el 8,3 %), los niveles de 25(OH)D eran menores de 10 ng/ml (límite inferior de la normalidad). Todos ellos estaban alimentados con lactancia materna (el 15,1 % del grupo) y ninguno estaba suplementado con vitamina D. Los lactantes con hipovitaminosis D tenían ligeramente elevadas las fosfatasas alcalinas. Sólo el 48 % de los lactantes alimentados al pecho recibían habitualmente suplementos de vitamina D. La media de niveles de 25(OH)D en invierno del grupo con lactancia materna (16,8 ng/ml) fue significativamente más baja que la del grupo con alimentación artificial en verano (23,6 ng/ml; p < 0,05). Conclusiones: La asociación de escasa exposición al sol y ausencia de suplementación con vitamina D confiere a los niños con lactancia materna un alto riesgo para la deficiencia subclínica de vitamina D, incluso en regiones de clima templado

Objective: To determine the prevalence of subclinical vitamin D deficiency among infants in Valencia, Spain (latitude 39.5 degrees N) and its relation with breast- feeding. Material and methods: Serum levels of calcium, phosphate, alkaline phosphatase, 25-hydroxyvitamin D (25-OHD) and intact parathyroid hormone (PTH) were measured in 60 term infants aged between 1 and 6 months (mean age: 3.9 months), with no known bone, gastrointestinal or renal disease (33 exclusively breast-fed, 27 bottle-fed). Data on vitamin D supplementation and weekly direct sunlight exposure were also gathered. Results: All infants had normal serum calcium, phosphate and PTH levels. Five infants (8.3 %) had 25-OHD levels < 10 ng/ml (lower limit of normality) and all of these infants were breast-fed (15.1 % of the group). None of these five infants received vitamin D supplementation. Infants with vitamin D deficiency had slightly elevated serum alkaline phosphatase. Only 48 % of breast-fed infants received regular vitamin D supplementation. The mean serum 25-OHD concentration of breast-fed infants in winter (16.8 ng/ml) was significantly lower than that in bottle- fed infants in summer (23.6 ng/ml, p < 0.05). Conclusions: In breast-fed infants, the association of limited sunshine exposure and poor dietary vitamin D supplementation confers a high risk of subclinical vitamin D deficiency, even in regions with a temperate climate

Risk factors for the development of food allergy.

Both genetic and environmental factors seem to predispose to the development of food allergy. A most notable factor is diet, particularly during infancy. Possible other factors include maternal diet during pregnancy and lactation, birth by cesarean section, exposure to tobacco smoke, multivitamin supplementation, and intake of antacids. It is important to identify and control such risk factors to reduce the development of food allergy.

Cytokines, infections, stress, and dysphoric moods in breastfeeders and formula feeders.

OBJECTIVE: To analyze relationships between stress, moods, and immunity in breastfeeding compared to formula-feeding mothers. DESIGN: A cross-sectional study of 181 healthy mothers, exclusively breastfeeding or formula feeding, studied at 4 to 6 weeks after childbirth. SETTING: Mothers were recruited in the postpartum unit of the hospital and then visited in their homes once at 4 to 6 weeks after childbirth for data collection. MAIN OUTCOME MEASURES: Stress, mood, infection symptoms, and serum levels of interferon-gamma and interleukin-10 were measured. RESULTS: Formula-feeding mothers had evidence of decreased interferon-gamma and a decreased serum Th1/Th2 ratio (interferon-gamma/interleukin-10) when perceived stress, dysphoric moods, and negative life events were high, an effect consistent with depression of cellular immunity. However, women who were breastfeeding did not show these relationships. CONCLUSIONS: The data suggest that breastfeeding confers some psychoneuroimmunological benefit to mothers, perhaps through prolactin or hypothalamic-hypophyseal-adrenocortical axis stress refractoriness.

Caries experience in preschool children referred for specialist dental care in hospital.

BACKGROUND: Increasing numbers of preschool children are being referred for specialist dental management in a paediatric hospital. Most cases have severe early childhood caries and require comprehensive management under general anaesthesia. The present study investigated risk factors for disease presence at initial consultation. METHODS: A convenience sample of 125 children under four years of age from the north Brisbane region were examined and caries experience recorded using dmft and dmfs indices. A self-administered questionnaire obtained information regarding social, demographic, birth, neonatal, infant feeding and dental health behaviour variables. The data were analysed using the chi-square and one-way analysis of variance procedures. RESULTS: Ninety-four per cent of referred children had severe ECC with mean dmft of 10.5 +/- 3.8 and mean dmfs of 27.1 +/- 15.1. Prevalence of severe ECC was significantly higher in children allowed a sweetened liquid in the infant feeding bottle (99 per cent) and allowed to sip from an infant feeding bottle during the day (100 per cent). Mean dmfs was significantly higher in children allowed to sleep with a bottle (28.7) and sip from a bottle during the day (29.9), children from a non-Caucasian background (31.8), those children that commenced regular toothbrushing between 6 to 12 months of age (28.1), had no current parental supervision of daily tooth-brushing (34.2) and had not taken daily fluoride supplements (27.8), vitamin supplements (27.8) or prescription medicine previously (27.6). CONCLUSIONS: The behavioural determinants for severe early childhood caries presence in hospital-referred children were similar to those identified in the regional preschool population.

Dietary exposure assessment of infants to bisphenol A from the use of polycarbonate baby milk bottles.

The residual bisphenol A (BPA) levels in 28 different brands of polycarbonate (PC) baby milk bottles available in the Singapore market were measured. With a detection limit of 3 mg/kg, BPA residues were detected in 19 out of the 28 PC baby milk bottles at levels between 4.01 and 141 mg/kg, with a mean of 28.1 +/- 31.4 mg/kg and a median of 17.2 mg/kg. The potential migration of BPA from each of the 28 PC milk bottles was also measured using food-simulating solvents and time conditions recommended by the US Food and Drug Administration (US FDA), but using temperatures more severe than actual use. The highest upper-bound mean BPA migration levels of 0.64 +/- 0.48 microg/in2 in 10% ethanol at 70 degrees C and 0.43 +/- 1.25 microg/in2 in corn oil at 100 degrees C were observed after incubating cut portions of the milk bottles for 240 h. With this migration data and using US FDA's procedure for estimation of dietary exposure, the worst-case dietary exposure assessment for the intake of BPA by infants between birth and three months of age was below the oral Reference Dose of 0.05 mg/kg bw/day established by the US Environmental Protection Agency. This study showed that the dietary exposure to BPA from actual uses of PC milk bottles is unlikely to pose a health risk in infants.

The cup-versus-bottle debate: a theme from an ethnographic study of the supplementation of breastfed infants in hospital in the United kingdom.

This article reports 1 theme from an ethnographic study that aimed to describe the experiences, expectations, and beliefs of mothers and health care professionals concerning supplementation in a UK maternity unit. Observation was conducted on the postnatal ward and the newborn infant unit, and 30 mothers, 17 midwives, 4 neonatal nurses, 3 health care assistants, 3 senior house officers, and 3 senior pediatricians gave in-depth interviews during a 9-month period in 2002. One of the major themes that emerged was the cup-versus-bottle debate. There were 3 categories strongly linked to this theme: difficulties returning to the breast, ease of use, and necessary skills and knowledge. It appears there is an urgent need to determine which is the best method of giving supplementary feeds, so that full, accurate information can be given to mothers, appropriate policies be devised, and the necessary resources and staff training be provided.

[Removal of sucking habits and myofunctional therapy: establishing swallowing and tongue rest position]. / Remoção de hábitos e terapia miofuncional: restabeleciimento da deglutição e repouso lingual.

BACKGROUND: The prolonged habit of pacifier sucking and the prolonged use of feeding bottle may cause myofunctional disorder, such as incorrect swallowing pattern and inadequate tongue rest position. AIM: To study the effect of myofunctional therapy (MFT) associated with the removal of the habit of pacifier sucking and the use of feeding bottle (REM) on the rehabilitation of swallowing and tongue rest position. METHOD: Two groups with ten children, ages ranging from four to four years and eight months, who initially presented a pacifier sucking habit and used the feeding bottle were studied. Children on REM group underwent the process of sucking habits removal using the Modified-Counselling Method, whereas children on MFT group underwent the same procedure associated to myofunctional therapy. Pre-treatment assessments were made, as well as 60 and 180 days post-treatment assessments. Data were analyzed using the statistical tests of Mann-Whitney and Wilcoxon (p < 0.05). RESULTS: Results indicate that children in the MFT group presented adequate swallowing patterns after 60 and 80 days, and presented adequate tongue rest position after 180 days. Children on the REM group, however, presented adequate swallowing pattern only after 180 days and did not present a significant improvement on the tongue rest position during the assessments. CONCLUSION: Myofunctional therapy associated to the removal of sucking habits presented a better and faster improvement of the swallowing pattern and of the tongue rest position.

Comprehensive approach to the management and prevention of early childhood caries.

Dental caries is the most common disease of childhood that does not resolve spontaneously or respond to a course of antibiotic therapy. Tragically, children in Hawaii experience the highest incidence of tooth decay in the United States. This manuscript briefly explains the etiology of Early Childhood Caries (ECC), describes the consequences of this insidious disease process and outlines a comprehensive, multidisciplinary, preventive approach for Hawaii's health care providers.

Risk indicators for tooth wear in New Zealand school children.

AIM: To investigate the prevalence and severity of tooth wear in the primary dentition of a representative sample of New Zealand school children and relate these to possible risk factors. DESIGN: A cross-sectional study. SETTING: Primary schools in Dunedin, New Zealand. PARTICIPANTS: 104 children of both sexes, aged between 5 and 8 years, randomly selected. METHODS: Clinical examinations of the buccal, occlusal/incisal and lingual surfaces of deciduous canines and molars. MAIN OUTCOME MEASURE: Degree of wear and the presence of dentinal cupping of teeth. Information on weaning and consumption of fruit-based drinks at bed time, frequency of consumption of fruits, yoghurt, pickled foods, fizzy and fruit-based drinks. RESULTS: The prevalence of tooth wear was similar in boys and girls and there were no significant differences between sides of the arches. A high percentage (82%) of children had at least one primary tooth with dentine exposed. While maxillary canines showed the greatest prevalence of dentine exposed, maxillary molars displayed the greatest prevalence of cupping. Severe tooth wear was less prevalent among children weaned after 12 months (14.3%) than those weaned earlier (27.9% P < 0.01). There were no statistically significant associations between wear and the consumption of fruit, yoghurt, pickled foods, fizzy drinks or fruit-based drinks. CONCLUSIONS: Tooth wear associated with dentine exposure is common in 5-8 year old children. This is not significantly associated with dietary factors, but appears to be related to early weaning from the breast.

Crecimiento, composición del incremento de peso y la absorción de minerales en recién nacidos a término alimentario con una nueva fórmula experimental conteniendo un hidrolizado de proteínas B-Palmitato y prebióticos / Growth, weight gain composition and mineral accretion in term infants fed a new experimental formula containing hydrolysed protein, B-palmitate and prebiotics

Objetivo: La leche materna es la alimentación de referencia para neonatos. Las fórmulas de leche con propiedades funcionales similares a la leche materna deberían ser programadas de modo que garanticen que el desarrollo del crecimiento y de los parámetros metabólicos conseguidos en los lactantes alimentados con fórmulas artificiales, son similares a los de los lactantes alimentados con lactancia materna. En el presente estudio sobre el crecimiento, se analizó en 14 recién nacidos a término alimentados con una fórmula nueva (FN) la composición del incremento de peso, la absorción de minerales y el desarrollo de la flora intestinal. Se compararon los resultados con los datos de los lactantes alimentados con lactancia materna (LM) y con lactantes alimentados con una fórmula estándar (FE).Metodología: Recién nacidos a término alimentados con fórmula reciben NF desde el nacimiento hasta la edad de dos meses. Las sustancias prebióticas en la NF fueron galacto y fructo-oligosacáridos (cantidad total: 0,4 g/100 ml). La NF contiene proteína de trigo parcialmente hidrolizada y B-palmitato (total ácido palmítico 0,6 g/100 ml; 41 por ciento en posición sn-2). La composición de la NF es idéntica a la de Omneo, excepto por la cantidad total de sustancias prebióticas. La tolerancia clínica, la ingesta de fórmula y las muestras de heces fueron obtenidas antes de la salida de la maternidad y a la edad de 3, 6 y 9 semanas. Se efectuaron análisis completos de la composición corporal mediante DEXA después del nacimiento, durante los primeros días de vida y a la edad de 2 meses. Se analizó el porcentaje de bifidobacterias existente en heces mediante "hibridación fluorescente in situ (FISH)".Resultados: 15 recién nacidos fueron enrolados en el estudio, uno de los recién nacidos se retiró debido a reflujo gastroesofágico. Las características antropométricas en el momento del nacimiento fueron: peso corporal 3318 ñ 406 g, longitud 50,0 ñ 1,7 cm, circunferencia craneal: 34,6 ñ 1,3 cm. Los datos de la investigación clínica obtenidos el día 3 ñ 1, día 25 ñ 4, día 45 ñ 4 y día 68 ñ 4 indican un volumen de ingesta y una evolución del peso corporal adecuados y excelente tolerancia a la alimentación. La media del incremento de peso corporal durante el período del estudio fue de 7,8 ñ 1,4 g/kg/d, incremento en la longitud: 0,91 ñ 0,19 cm/sem, circunferencia craneal: 0, 62 ñ 0, 09 cm/sem. La composición del incremento de peso fue 61 por ciento de masa corporal, 37,2 por ciento de masa grasa y 1,5 por ciento de masa mineral ósea. Por lo tanto, entre los días 3 ñ 1 y 68 + 4: la masa de grasa se incrementó de 12,6 a 22,6 por ciento, el contenido de mineral óseo de 56,7 a 90,9 g, y el área ósea de 295 a 430 crn2 mientras que el índice de densidad volumétrica mineral del hueso experimentó un descenso de 11,1 a 10,1. El porcentaje medio de bífidobacteria en las muestras fecales recogidas a la edad de 3 ñ 1 días fue de 21 por ciento. A la edad de 25Iñ 4, 45 ñ 4 y 68 ñ 4 días esta proporción fue 53, 56 y 50 por ciento indicando un rápido efecto bifidogénico de la NF y la capacidad de la NF para mantener una flora bifidobacterial estable. Conclusiones: El crecimiento y la calidad del crecimiento de los lactantes alimentados con la fórmula nueva (FN) fueron similares a los alimentados con lactancia materna (LM) y a los alimentados con fórmulas de inicio estándares (FE). El ligero descenso en la densidad volumétrica del hueso, debido al incremento en el área ósea superior al incremento en la densidad mineral del hueso durante este período de rápido crecimiento, fue similar a nuestros resultados previos en lactantes alimentados con LM y FE (EJP en prensa). La utilización de prebióticos en FN, dio como resultado un incremento rápido y significativo del porcentaje de bifidobacteria endógena y la capacidad de mantener una flora intestinal estable durante los primeros meses de vida (AU)

Initial management of breastfeeding.

Breast milk is widely accepted as the ideal source of nutrition for infants. In order to ensure success in breastfeeding, it is important that it be initiated as early as possible during the neonatal period. This is facilitated by skin-to-skin contact between the mother and infant immediately following birth. When possible, the infant should be allowed to root and latch on spontaneously within the first hour of life. Many common nursery routines such as weighing the infant, administration of vitamin K and application of ocular antibiotics can be safely delayed until after the initial breastfeeding. Postpartum care practices that improve breastfeeding rates include rooming-in, anticipatory guidance about breastfeeding problems and the avoidance of formula supplementation and pacifiers.

Serum bilirubin levels at 72 hours by selected characteristics in breastfed and formula-fed term infants delivered by cesarean section.

UNLABELLED: The present multicenter study analysed the relative impact of maternal and infant factors on serum bilirubin levels at 72 +/- 12 h in exclusively breastfed vs formula-fed term infants. End-tidal carbon monoxide levels corrected for ambient air (ETCOc), an index of bilirubin production, were measured in exclusively breastfed (B = 66) or formula-fed (F = 210) term infants at 2-8 h of age. Inclusion criteria included cesarean section to ensure a 3 d hospitalization, birthweight > or = 2,500 g, gestational age >37 wk and absence of any illness. The ETCOc for B infants and F infants did not differ significantly (1.3 +/- 0.7 ppm vs 1.3 +/- 0.8 ppm). The serum bilirubin level at 72 +/- 12 h was significantly higher in B infants than in F infants (8.5 +/- 3.4mg dl(-1) vs 6.7 +/- 3.4mg dl(-1) p < 0.001), as was the percentage weight loss from birthweight. Serum bilirubin levels were significantly higher in infants who were male, who did not have meconium-stained amniotic fluid, and in those whose mothers were insulin-dependent diabetics or hypertensive. There was no difference between groups in the need for phototherapy or exchange transfusion. CONCLUSION: Although higher bilirubin levels were observed in group B at 72 +/- 12 h compared with group F, this finding was not of clinical or therapeutic consequence in this study. The lack of difference in ETCOc between the groups may be a factor of the timing of ETCOc measurement in this study, or may suggest that early increased bilirubin production is not a significant contributor to jaundice observed in exclusively breastfed infants. Key words: bilirubin, breastfeeding, jaundice

Influencia del entorno ambiental y tipo de régimen dietético en la incidencia, duración e intensidad de los procesos infecciosos del lactante / The role of environmental factors and type of dietary regimen on morbidity in young infants

Objetivo. Estudiar las enfermedades infecciosas y su relación con el entorno ambiental en lactantes, desde su nacimiento hasta los 4 meses de edad. Material y Métodos. Han intervenido más de 600 pediatras. Se incluyó a niños de hasta 20 días que fueron reevaluados cuando tenían 4 meses, para estudiar las complicaciones infecciosas aparecidas. Análisis estadístico mediante regresión logística. Resultados. Se incluyeron 3.428 niños a término. Las infecciones oftálmicas fueron las más frecuentes (5,5 por ciento). Las bronquitis y neumonías las más graves (61 por ciento moderadas-graves) y de mayor duración (6,5 ñ 3 días). La polución, entorno fumador y convivencia con hermanos constituyen factores de riesgo. A los 4 meses, la administración de una fórmula sin nucleótidos se añadió a los factores de riesgo previos. Conclusiones. El entorno ambiental es importante en la incidencia de enfermedades infecciosas en el lactante. El riesgo aumenta por: asistencia a guarderías, polución y ambiente fumador. La alimentación con leche materna y una fórmula con nucleótidos son favorables para el desarrollo inmunológico de los lactantes. (AU)

Nursing-bottle syndrome caused by prolonged drinking from vessels with bill-shaped extensions.

Our investigating 186 infants between the ages of one and six with carious destruction of the maxillary primary incisors, it was learned which risk factors were responsible for the condition known as nursing bottle syndrome. One hundred and twenty-eight infants (68.8 percent) were given a nursing bottle, twelve (6.5 percent) a feeding cup or other bottles with bill- shaped extensions, and forty-one (22.0 percent) both a nursing bottle and vessels with bill-shaped extensions; in all cases the feeding was excessive and prolonged beyond the first year of life. An additional five infants (2.7 percent) were breast-fed excessively beyond the first year. The results confirm the risk of tooth destruction, typical of nursing bottle syndrome, by prolonged and frequent consumption of cariogenic beverages from vessels with bill-shaped extensions. It is important, therefore, that a warning regarding dental health hazards of such feeding methods be issued.

Stereoacuity at age 3.5 y in children born full-term is associated with prenatal and postnatal dietary factors: a report from a population-based cohort study.

BACKGROUND: Observational studies suggested that breast-feeding benefits the visual development of preterm children, which has been attributed to the presence of docosahexaenoic acid (DHA) in breast milk but not most formula milks. Randomized studies showed that preterm children require a dietary supply of DHA in the first few weeks of life for optimal visual development, but it is unclear whether full-term children experience similar benefits from breast milk or DHA supplements. OBJECTIVE: The objective of this study was to compare stereoacuity at age 3.5 y in healthy, full-term children who were breast-fed and in similar children who had not been breast-fed after adjustment for socioeconomic status and maternal diet. DESIGN: Prospectively collected data on maternal diet during pregnancy (including intake of oily fish), the child's diet, and the socioeconomic status of the family were examined. Stereoacuity at age 3.5 y was assessed. RESULTS: Children who had been breast-fed for 4 mo were more likely to achieve high-grade stereopsis, or stereoscopic vision, than were children who had not been breast-fed (adjusted odds ratio: 2.77; 95% CI: 1.54, 4.97). The mother's antenatal blood DHA content was associated with her intake of oily fish (P < 0.0001). Children whose mothers ate oily fish during pregnancy were also more likely to achieve high-grade stereopsis than were children whose mothers did not eat oily fish (adjusted odds ratio: 1.57; 95% CI: 1.00, 2.45). CONCLUSIONS: The results of this study suggest that for full-term infants, breast-feeding is associated with enhanced stereopsis at age 3.5 y, as is a maternal DHA-rich antenatal diet, irrespective of later infant feeding practice.

How to promote & provide functional jaw orthopedics.

This article outlines how to promote and provide Functional Jaw Orthopedic (FJO) treatment, which is unique medical dentistry. FJO treatment is valuable preventive and therapeutic medical dentistry because jaw treatment impacts the extensive structures that surround the human airway and adjoin the skull. To best provide the broad range of unique FJO treatments, dentists need extensive knowledge, skills and experience. In order to promote FJO treatments, dentists and other interested health care providers need a wide assortment of educational materials that clearly show FJO treatment options and benefits.

Eighteen-month follow-up of infants fed evaporated milk formula.

In parts of Canada including Newfoundland and Labrador and among Aboriginal peoples, infants still consume evaporated milk (EM) formulas for cultural and economic reasons. At 3 and 6 months, full-term infants fed EM (n = 30) received low intakes of iron, thiamine, selenium and had higher weight velocity than breastfed (BF, n = 29) infants. EM infants had greater anemia, lowered transketolase activity (thiamine) and lowered glutathione peroxidase (selenium) activity (p < 0.05). To determine the later effect of early feeding deficit on nutritional status, we examined these same infants at 18 months of age. At that time, there were no differences in dietary intakes of energy, protein, zinc, copper, selenium and iron, nor in plasma levels of zinc, copper, vitamin C, nor in red blood cell activity levels of glutathione reductase (riboflavin), transketolase, glutathione peroxidase, nor in superoxide dismutase. However, EM infants weighed more and were more likely to visit a physician, have anemia, and have iron depletion than were BF infants. We conclude that infants consuming evaporated milk formulas should receive iron supplements throughout infancy.