Family influences on child nutritional outcomes in Nairobi's informal settlements.

BACKGROUND: Improving child nutritional status is an important step towards achieving the Sustainable Development Goals 2 and 3 in developing countries. Most child nutrition interventions in these countries remain variably effective because the strategies often target the child's mother/caregiver and give limited attention to other household members. Quantitative studies have identified individual level factors, such as mother and child attributes, influencing child nutritional outcomes. METHODS: We used a qualitative approach to explore the influence of household members on child feeding, in particular, the roles of grandmothers and fathers, in two Nairobi informal settlements. Using in-depth interviews, we collected data from mothers of under-five children, grandmothers, and fathers from the same households. RESULTS: Our findings illustrate that poverty is a root cause of poor nutrition. We found that mothers are not the sole decision makers within the household regarding the feeding of their children, as grandmothers appear to play key roles. Even in urban informal settlements, three-generation households exist and must be taken into account. Fathers, however, are described as providers of food and are rarely involved in decision making around child feeding. Lastly, we illustrate that promotion of exclusive breastfeeding for 6 months, as recommended by the World Health Organization, is hard to achieve in this community. CONCLUSIONS: These findings call for a more holistic and inclusive approach for tackling suboptimal feeding in these communities by addressing poverty, targeting both mothers and grandmothers in child nutrition strategies, and promoting environments that support improved feeding practices such as home-based support for breastfeeding and other baby-friendly initiatives.

The Evaluation and Treatment of Tall Stature in Preadolescent Girls: A Case Report.

Families may approach primary care providers for advice and treatment for tall stature (height more than two standard deviations above the mean height for a given age) in pre-pubertal children. The following case report describes an 11-year-old girl who was referred to an endocrinology specialist for familial tall stature. Potential pathological causes for tall stature are reviewed. The assessment, management, and risks and benefits of treatment for this condition are described. Finally, the role of the pediatric nurse practitioner in caring for youth with this chief complaint is discussed.

Desempenho cognitivo de pré-escolares com baixa estatura em tratamento de recuperação nutricional / Cognitive performance of stunted pre-school children undergoing nutritional recovery treatment

RESUMO Objetivo: Determinar se o tratamento de crianças com baixa estatura, ofertado em um centro especializado, influencia seu desempenho cognitivo. Métodos: Foram analisados dois grupos de crianças advindas de famílias vulneráveis, um com crianças com baixa estatura em tratamento no Centro de Recuperação e Educação Nutricional (CREN) e outro de crianças eutróficas de uma creche municipal localizada na mesma região do CREN. No CREN, as crianças são tratadas em semi-internato (9 horas/dia, 5 dias/semana), recebendo suporte médico, nutricional e psicopedagógico. Todas foram submetidas ao Teste de Triagem do Desenvolvimento de Denver-II e avaliadas quanto ao índice de estatura-para-idade em 3 momentos distintos: no início do acompanhamento e após 6 e 12 meses. A classificação socioeconômica das crianças, de acordo com os Critérios de Classificação Econômica Brasil, foi feita no início do acompanhamento. Calcularam-se razões de prevalência para a análise transversal da linha de base, por meio de uma regressão de Poisson, e razões de prevalência agrupadas para a análise longitudinal, por meio de um modelo de estimativas de equações generalizadas, ambas ajustadas por idade, sexo e classe socioeconômica. Resultados: Ao todo, 74 crianças foram analisadas, 37 em cada grupo. Não houve diferenças de idade, sexo e classe socioeconômica entre os grupos. Na análise longitudinal, o grupo CREN apresentou melhor desempenho no domínio pessoal-social (razão de prevalência agrupada: 0,89; intervalo de confiança de 95% - IC95%: 0,82-0,95), sem diferenças significativas para os demais domínios. Conclusão: O tratamento ofertado pelo CREN melhorou satisfatoriamente as habilidades sociais das crianças tratadas, sem alterar os demais domínios.

ABSTRACT Objective: To determine if the treatment of stunted children offered at a specialized center influences their cognitive performance. Methods: Two groups of children from vulnerable families were selected, one consisting of stunted children being treated at the Nutrition Education and Recovery Center (CREN), and the other group of eutrophic children from a local, public day care center. At CREN, children are treated in a day-hospital system (9 hours/day, 5 days/week), receiving medical, nutritional and psycho-pedagogical support. All children were submitted to the Denver-II Development Screening Test and had their development and the height-for-age index assessed at 3 moments: at the beginning of the follow-up, and after 6 and 12 months. The socioeconomic status, according to the Brazilian Economic Classification Criteria, was assessed at the beginning of the follow-up. Data were treated by prevalence ratios for cross-sectional baseline analysis, using the Poisson regression, and by pooled prevalence ratios for longitudinal analysis, using a generalized equation estimation model, both adjusted by age, sex and economic status. Results: Seventy-four children were included, 37 for each group. There were no differences in age, sex and socioeconomic status between groups. In the longitudinal analysis, the CREN group showed better performance in the personal-social domain (pooled prevalence ratio: 0.89; 95% confidence interval - 95%IC 0.82-0.95), with no differences in the other domains. Conclusions: The treatment offered at CREN satisfactorily improved the social skills of the treated children, without changing other domains.

COGNITIVE PERFORMANCE OF STUNTED PRE-SCHOOL CHILDREN UNDERGOING NUTRITIONAL RECOVERY TREATMENT. / DESEMPENHO COGNITIVO DE PRÉ-ESCOLARES COM BAIXA ESTATURA EM TRATAMENTO DE RECUPERAÇÃO NUTRICIONAL.

OBJECTIVE: To determine if the treatment of stunted children offered at a specialized center influences their cognitive performance. METHODS: Two groups of children from vulnerable families were selected, one consisting of stunted children being treated at the Nutrition Education and Recovery Center (CREN), and the other group of eutrophic children from a local, public day care center. At CREN, children are treated in a day-hospital system (9 hours/day, 5 days/week), receiving medical, nutritional and psycho-pedagogical support. All children were submitted to the Denver-II Development Screening Test and had their development and the height-for-age index assessed at 3 moments: at the beginning of the follow-up, and after 6 and 12 months. The socioeconomic status, according to the Brazilian Economic Classification Criteria, was assessed at the beginning of the follow-up. Data were treated by prevalence ratios for cross-sectional baseline analysis, using the Poisson regression, and by pooled prevalence ratios for longitudinal analysis, using a generalized equation estimation model, both adjusted by age, sex and economic status. RESULTS: Seventy-four children were included, 37 for each group. There were no differences in age, sex and socioeconomic status between groups. In the longitudinal analysis, the CREN group showed better performance in the personal-social domain (pooled prevalence ratio: 0.89; 95% confidence interval - 95%IC 0.82-0.95), with no differences in the other domains. CONCLUSIONS: The treatment offered at CREN satisfactorily improved the social skills of the treated children, without changing other domains.

OBJETIVO: Determinar se o tratamento de crianças com baixa estatura, ofertado em um centro especializado, influencia seu desempenho cognitivo. MÉTODOS: Foram analisados dois grupos de crianças advindas de famílias vulneráveis, um com crianças com baixa estatura em tratamento no Centro de Recuperação e Educação Nutricional (CREN) e outro de crianças eutróficas de uma creche municipal localizada na mesma região do CREN. No CREN, as crianças são tratadas em semi-internato (9 horas/dia, 5 dias/semana), recebendo suporte médico, nutricional e psicopedagógico. Todas foram submetidas ao Teste de Triagem do Desenvolvimento de Denver-II e avaliadas quanto ao índice de estatura-para-idade em 3 momentos distintos: no início do acompanhamento e após 6 e 12 meses. A classificação socioeconômica das crianças, de acordo com os Critérios de Classificação Econômica Brasil, foi feita no início do acompanhamento. Calcularam-se razões de prevalência para a análise transversal da linha de base, por meio de uma regressão de Poisson, e razões de prevalência agrupadas para a análise longitudinal, por meio de um modelo de estimativas de equações generalizadas, ambas ajustadas por idade, sexo e classe socioeconômica. RESULTADOS: Ao todo, 74 crianças foram analisadas, 37 em cada grupo. Não houve diferenças de idade, sexo e classe socioeconômica entre os grupos. Na análise longitudinal, o grupo CREN apresentou melhor desempenho no domínio pessoal-social (razão de prevalência agrupada: 0,89; intervalo de confiança de 95% - IC95%: 0,82-0,95), sem diferenças significativas para os demais domínios. CONCLUSÃO: O tratamento ofertado pelo CREN melhorou satisfatoriamente as habilidades sociais das crianças tratadas, sem alterar os demais domínios.

Implementation of an enhanced probation program: evaluating process and preliminary outcomes.

Supervision, Monitoring, Accountability, Responsibility, and Treatment (SMART) is Kentucky's enhanced probation pilot program modeled after Hawaii's Opportunity Probation with Enforcement (HOPE). SMART is proposed to decrease substance use, new violations, and incarceration-related costs for high-risk probationers by increasing and randomizing drug testing, intensifying supervision, and creating linkages with needed resources (i.e., mental health and substance use). SMART adopts a holistic approach to rehabilitation by addressing mental health and substance abuse needs as well as life skills for fostering deterrence of criminal behavior vs. punitive action only. A mixed methods evaluation was implemented to assess program implementation and effectiveness. Qualitative interviews with key stakeholders (i.e., administration, judges, attorneys, and law enforcement/corrections) suggested successful implementation and collaboration to facilitate the pilot program. Quantitative analyses of secondary Kentucky Offender Management System (KOMS) data (grant Year 1: 07/01/2012-06/30/2013) also suggested program effectiveness. Specifically, SMART probationers showed significantly fewer: violations of probation (1.2 vs. 2.3), positive drug screens (8.6% vs. 29.4%), and days incarcerated (32.5 vs. 118.1) than comparison probationers. Kentucky's SMART enhanced probation shows preliminary success in reducing violations, substance use, and incarceration. Implications for practice and policy will be discussed.

Growth in children with chronic kidney disease: role of nutrition, growth hormone, dialysis, and steroids.

PURPOSE OF REVIEW: Children with chronic kidney disease (CKD) have impaired growth that leads to short stature in adulthood. The problem persists even with successful transplantation and steroid withdrawal protocols. The aim of this review is to provide an overview of the pressing issues related to growth failure in children with CKD both before and after transplantation. RECENT FINDINGS: Although great strides have been made in dialysis and transplantation, the incidence of abnormal adult height in children growing up with CKD remains as high as 45-60%. The lack of catch-up growth and resultant short stature is a critical issue for self-esteem and quality of life in many children with CKD. Aggressive daily dialysis, improved nutrition, treatment of metabolic bone disease, and the use of recombinant human growth hormone provide some hope for catch-up growth in select patients. SUMMARY: The causes of growth failure in the setting of CKD are multifactorial. Attention to all the details by optimizing nutritional, bone and mineral metabolism, correcting metabolic acidosis and anemia, achieving excellent blood pressure control, reversing cardiovascular complications such as left ventricular hypertrophy, and minimizing the use of corticosteroids is the current standard of care. Aggressive daily dialysis can reverse many of the uremic derangements. For patients not yet on dialysis or for those after renal transplant, early institution of recombinant human growth hormone can promote growth. Improved understanding of the mechanisms of hormone resistance may offer novel targets or measurements of treatment effectiveness.

Postnatal origins of undernutrition.

Obesity and nutrition-related chronic disorders are fast rising in developing countries. But undernutrition--stunting, underweight, wasting and micronutrient deficiencies--still affect millions of preschool children in both rural and urban settings increasing the risks of morbidity and mortality, impairing cognitive development, reducing productivity and increasing the risk of chronic diseases in later life. In addition undernutrition has a transgenerational effect. Here I review the evidence for a synergistic effect of inadequate nutrition (breastfeeding, complementary feeding), infection, and inappropriate mother-child interactions on growth and nutritional deficiencies. Underlying socioeconomic, environmental and genetic factors are also explored. Finally some perspectives on how urbanization and globalization may affect the prevalence and distribution of undernutrition are discussed. Fighting child under-nutrition is still an urgent necessity and a moral imperative.

Early childhood stunting is associated with poor psychological functioning in late adolescence and effects are reduced by psychosocial stimulation.

Stunting is associated with deficits in cognition and school achievement from early childhood to late adolescence; however, there has been little investigation of emotional and behavioral outcomes. The objective of this study was to determine whether linear growth retardation (stunting) in early childhood is associated with poorer psychological functioning in late adolescence. The study was a prospective cohort study of stunted and nonstunted children. Participants were identified at age 9-24 mo by a survey of poor neighborhoods in Kingston, Jamaica, and a 2-y intervention trial of supplementation and stimulation was conducted in the stunted children. Psychological functioning was assessed at age 17 y in 103 of 129 stunted children enrolled and 64 of 84 nonstunted participants. Anxiety, depressive symptoms, self-esteem, and antisocial behavior were reported by participants using interviewer-administered questionnaires and attention deficit, hyperactivity, and oppositional behavior were reported by parent interviews. The stunted participants reported significantly more anxiety (regression coefficient = 3.03; 95% CI = 0.99, 5.08) and depressive symptoms (0.37; 95% CI = 0.01, 0.72) and lower self-esteem (-1.67; 95% CI = -0.38, -2.97) than nonstunted participants and were reported by their parents to be more hyperactive (1.29; 95% CI = 0.12, 2.46). Effect sizes were 0.4-0.5 SD. Participants who received stimulation in early childhood differed from the nonstunted group in hyperactivity only. Children stunted before age 2 y thus have poorer emotional and behavioral outcomes in late adolescence. The findings expand the range of disadvantages associated with early stunting, which affects 151 million children <5 y old in developing countries.