Dificultades alimentarias en la infancia: una revisión narrativa / Feeding difficulties in childhood: A narrative review

Se estima que entre el 25 % y el 40 % de los niños sanos presentan algún síntoma de dificultad alimentaria (DA) durante su crecimiento y desarrollo, y muchas veces no son adecuadamente diagnosticadas. El propósito de este trabajo consistió en realizar una revisión narrativa que reuniera la información disponible sobre las dificultades alimentarias. Se desarrollaron algoritmos de evaluación y abordaje a partir de la evidencia en la literatura. La mayoría de los problemas de alimentación en los niños pequeños (selectividad alimentaria, falta de apetito, miedo a la alimentación) a menudo coexisten y es necesario evaluar el riesgo clínico para planificar una intervención individualizada. Contar con definiciones estandarizadas y terminología común para abordar estas dificultades de manera adecuada y multidisciplinaria es uno de los caminos para optimizar su tratamiento. Involucrar a los diferentes profesionales de la salud y a los padres es fundamental para abordar las dificultades alimentarias.

It has been estimated that between 25% and 40% of healthy children show symptoms of feeding difficulties (FDs) during their growth and development; many times, these are not adequately diagnosed. The objective of this study was to conduct a narrative review that collected the available information on fee ding difficulties. Assessment and management algorithms were developed based on the bibliographic evidence. Most feeding problems in young children (feeding selectivity, loss of appetite, fear of feeding) are often con current, and a clinical risk assessment is necessary to plan an individualized intervention. Having standardized definitions and common terms to address these difficulties in an appropriate and multidisciplinary manner is one of the ways to optimize their treatment. The involvement of different health care providers and parents is critical to address feeding difficulties.

Feeding difficulties in childhood: A narrative review. / Dificultades alimentarias en la infancia: una revisión narrativa.

It has been estimated that between 25% and 40% of healthy children show symptoms of feeding difficulties (FDs) during their growth and development; many times, these are not adequately diagnosed. The objective of this study was to conduct a narrative review that collected the available information on feeding difficulties. Assessment and management algorithms were developed based on the bibliographic evidence. Most feeding problems in young children (feeding selectivity, loss of appetite, fear of feeding) are often concurrent, and a clinical risk assessment is necessary to plan an individualized intervention. Having standardized definitions and common terms to address these difficulties in an appropriate and multidisciplinary manner is one of the ways to optimize their treatment. The involvement of different health care providers and parents is critical to address feeding difficulties.

Se estima que entre el 25 % y el 40 % de los niños sanos presentan algún síntoma de dificultad alimentaria (DA) durante su crecimiento y desarrollo, y muchas veces no son adecuadamente diagnosticadas. El propósito de este trabajo consistió en realizar una revisión narrativa que reuniera la información disponible sobre las dificultades alimentarias. Se desarrollaron algoritmos de evaluación y abordaje a partir de la evidencia en la literatura. La mayoría de los problemas de alimentación en los niños pequeños (selectividad alimentaria, falta de apetito, miedo a la alimentación) a menudo coexisten y es necesario evaluar el riesgo clínico para planificar una intervención individualizada. Contar con definiciones estandarizadas y terminología común para abordar estas dificultades de manera adecuada y multidisciplinaria es uno de los caminos para optimizar su tratamiento. Involucrar a los diferentes profesionales de la salud y a los padres es fundamental para abordar las dificultades alimentarias.

CROSS-CULTURAL ADAPTATION AND VALIDATION OF THE MONTREAL CHILDREN'S HOSPITAL FEEDING SCALE INTO BRAZILIAN PORTUGUESE.

OBJECTIVE: To cross-culturally adapt and validate the Montreal Children's Hospital Feeding Scale (MCH-FS) into Brazilian Portuguese. METHODS: The MCH-FS, originally validated in Canada, was validated in Brazil as Escala Brasileira de Alimentação Infantil (EBAI) and developed according to the following steps: translation, production of the Brazilian Portuguese version, testing of the original and the Brazilian Portuguese versions, back-translation, analysis by experts and by the developer of the original questionnaire, and application of the final version. The EBAI was applied to 242 parents/caregivers responsible for feeding children from 6 months to 6 years and 11 months of age between February and May 2018, with 174 subjects in the control group and 68 ones in the case group. The psychometric properties evaluated were validity and reliability. RESULTS: In the case group, 79% of children were reported to have feeding difficulties, against 13% in the control group. The EBAI had good internal consistency (Cronbach's alpha=0.79). Using the suggested cutoff point of 45, the raw score discriminated between cases and controls with a sensitivity of 79.4% and specificity of 86.8% (area under the ROC curve=0.87). CONCLUSIONS: The results obtained in the validation process of the EBAI demonstrate that the questionnaire has adequate psychometric properties and, thus, can be used to identify feeding difficulties in Brazilian children from 6 months to 6 years and 11 months of age.

Cross-cultural adaptation and validation of the montreal children's hospital feeding scale into brazilian portuguese / Adaptação transcultural e validação da montreal children's hospital feeding scale para o português falado no brasil

ABSTRACT Objective: To cross-culturally adapt and validate the Montreal Children's Hospital Feeding Scale (MCH-FS) into Brazilian Portuguese. Methods: The MCH-FS, originally validated in Canada, was validated in Brazil as Escala Brasileira de Alimentação Infantil (EBAI) and developed according to the following steps: translation, production of the Brazilian Portuguese version, testing of the original and the Brazilian Portuguese versions, back-translation, analysis by experts and by the developer of the original questionnaire, and application of the final version. The EBAI was applied to 242 parents/caregivers responsible for feeding children from 6 months to 6 years and 11 months of age between February and May 2018, with 174 subjects in the control group and 68 ones in the case group. The psychometric properties evaluated were validity and reliability. Results: In the case group, 79% of children were reported to have feeding difficulties, against 13% in the control group. The EBAI had good internal consistency (Cronbach's alpha=0.79). Using the suggested cutoff point of 45, the raw score discriminated between cases and controls with a sensitivity of 79.4% and specificity of 86.8% (area under the ROC curve=0.87). Conclusions: The results obtained in the validation process of the EBAI demonstrate that the questionnaire has adequate psychometric properties and, thus, can be used to identify feeding difficulties in Brazilian children from 6 months to 6 years and 11 months of age.

RESUMO Objetivo: Realizar a adaptação transcultural e a validação da escala Montreal Children's Hospital Feeding Scale (MCH-FS) para a língua portuguesa falada no Brasil. Métodos: A MCH-FS, originalmente validada no Canadá, foi validada no Brasil como Escala Brasileira de Alimentação Infantil (EBAI) e desenvolvida a partir das seguintes etapas: tradução, montagem da versão em português brasileiro, teste da versão em inglês e da versão em português brasileiro, retrotradução, análise por experts e autora do questionário original e aplicação da versão final em estudo. A EBAI foi aplicada em 242 pais/cuidadores responsáveis pela alimentação de crianças de seis meses a seis anos e 11 meses de idade no período de fevereiro a maio de 2018, sendo 174 no grupo controle e 68 no grupo dos casos. As propriedades psicométricas avaliadas foram validade e confiabilidade. Resultados: No grupo dos casos, 79% dos pais/cuidadores relataram dificuldades alimentares, e no grupo controle, 13%. A EBAI apresentou boa consistência interna (alfa de Cronbach=0,79). Utilizando-se o ponto de corte sugerido de 45, o escore bruto (raw score) diferenciou casos de controles com sensibilidade de 79,4% e especificidade de 86,8% (área sob a curva ROC=0,87). Conclusões: Os resultados obtidos na validação da EBAI evidenciaram medidas psicométricas adequadas. Portanto, a escala pode ser utilizada na identificação de dificuldades alimentares em crianças brasileiras de seis meses a seis anos e 11 meses idade.

Instrument to Identify Food Neophobia in Brazilian Children by Their Caregivers.

This study aimed to develop a specific instrument to evaluate food neophobia focused on Brazilian children and to perform the content validation and internal semantic consistency and reproducibility evaluation of the instrument. Three steps were necessary to conduct the study: (i) development of the instrument, (ii) internal validation (content validation and semantic evaluation) of the food neophobia instrument using 22 experts in the first round and 20 of them in the second round, (iii) evaluation of the internal consistency and reproducibility of the instrument with the children's caregivers, using the test-retest (where the same caregiver-n = 22-answered twice, with 24 h interval) and comparing responses between two caregivers (n = 44) of the same children (n = 22). We developed an instrument in Brazilian-Portuguese to evaluate children's food neophobia based on the caregivers' perceptions with 25 items divided into three domains (neophobia in general, neophobia for fruits and neophobia for vegetables). Our results indicated that the instrument has excellent internal consistency (>0.9) and reproducibility (>0.9) when answered by the caregiver who knows the child's eating habits, indicating reliability to be applied in Brazil. In addition, when the two caregivers answered the instrument, we found a good reproducibility (>0.6), confirming the possibility to be answered by one of the caregivers. Further studies are necessary to complete external validation with a representative sample of the target group in Brazil, showing nationwide the profile of the population. The potential of a neophobia study would contribute to the implementation of effective strategies and guidelines to support parents and health professionals, especially those involved in health and nutrition, to identify traces of food neophobia or neophobic behavior. By accurately measuring food neophobia in children, families can prevent nutritional deficiencies throughout adolescence and adulthood, improving eating habits. Children usually have neophobias similar to the ones presented by their parents-and when early detected, these neophobias can be addressed.

Psychometric Properties of the Infant and Child Feeding Questionnaire.

OBJECTIVES: To report the updated psychometric properties of a child feeding questionnaire and to report the psychometric properties of a screening tool developed from this questionnaire. A secondary objective was to consider if items from a behavior checklist embedded within the Infant and Child Feeding Questionnaire may be useful in making referrals for feeding problems. STUDY DESIGN: Caregivers of children younger than the age of 4 years with pediatric feeding disorders (as defined by International Classification of Diseases, Ninth Revision, criteria) were recruited from 2 outpatient clinics. A comparison group with no feeding problems was recruited during well child checks from community clinics. Caregivers completed a demographic questionnaire and a child feeding questionnaire. Exploratory and confirmatory analyses identified questionnaire items that differentiated groups. Remaining items were summed and area under the curve, sensitivity, and specificity values were calculated to describe the resulting screening tool. ORs of behaviors from the embedded behavior checklist were calculated to determine whether specific behaviors could be useful for referrals. RESULTS: Responses of 989 caregivers (pediatric feeding disorders, n = 331; no feeding problems, n = 650) were obtained. Six questions of the child feeding questionnaire differentiated groups accounting for 60% of variance. Sensitivity (73%) and specificity (93%) were greater when any 2 or more of these 6 items was endorsed. Three items of the embedded feeding behaviors checklist show promise for referrals to specific provider disciplines. CONCLUSIONS: A pediatric feeding disorders screening tool consisting of 6 questions from a child feeding questionnaire is psychometrically sound. Use of this tool may expedite referrals for treatment. Further study of the embedded behavior checklist may be useful for clinical referrals.

High Cost and Low Yield: The Diagnostic Evaluation of Rumination Syndrome in Pediatrics.

OBJECTIVE: To document the use of diagnostic testing in adolescents who ultimately were diagnosed with rumination syndrome, a functional gastrointestinal disorder. We examined the diagnostic yield of each test as well as the associated costs, and we determined if any demographic or illness-related variables impacted the magnitude of the work-up. STUDY DESIGN: A retrospective chart review was conducted for 68 patients with rumination syndrome admitted to our inpatient treatment program. The cost and findings of patients' diagnostic investigations were gathered, as well as demographic and illness-related variables to determine factors that may be related to evaluation size. RESULTS: The most commonly used tests in the evaluation of rumination syndrome included esophagogastroduodenoscopy, gastric emptying, antroduodenal manometry, upper gastrointestinal series, and abdominal ultrasound scan. Each patient underwent an average of 8.8 tests, with the average cost for each patient's diagnostic work-up being US $19 795. Few tests were found to be beneficial in the diagnosis of rumination syndrome, and few demographic or illness variables were found to be related to the overall extent of the investigation. CONCLUSIONS: Extensive testing for rumination syndrome in adolescents is common in clinical practice, and comes at a high financial cost with low yield, likely delaying diagnosis and treatment. Symptom-based criteria should be used to make the diagnosis of rumination syndrome.

Association between feeding difficulties and language delay in preterm infants using Bayley Scales of Infant Development-Third Edition.

OBJECTIVE: To evaluate the relationship between abnormal feeding patterns and language performance on the Bayley Scales of Infant Development-Third Edition at 18-22 months adjusted age among a cohort of extremely premature infants. STUDY DESIGN: This is a descriptive analysis of 1477 preterm infants born ≤ 26 weeks gestation or enrolled in a clinical trial between January 1, 2006 and March 18, 2008 at a National Institute of Child Health and Human Development Neonatal Research Network center who completed the 18-month neurodevelopmental follow-up assessment. At 18-22 months adjusted age, a comprehensive neurodevelopmental evaluation was performed by certified examiners including the Receptive and Expressive Language Subscales of the Bayley Scales of Infant Development-Third Edition and a standardized adjusted age feeding behaviors and nutritional intake. Data were analyzed using bivariate and multilevel linear and logistic regression modeling. RESULTS: Abnormal feeding behaviors were reported in 193 (13%) of these infants at 18-22 months adjusted age. Abnormal feeding patterns, days of mechanical ventilation, hearing impairment, and Gross Motor Functional Classification System level ≥ 2 each independently predicted lower composite language scores. CONCLUSIONS: At 18 months adjusted age, premature infants with a history of feeding difficulties are more likely to have language delay. Neuromotor impairment and days of mechanical ventilation are both important risk factors associated with these outcomes.

Desarrollo de la conducta alimentaria en la infancia y sus alteraciones / Development of feeding behavior in childhood and its alterations

El desarrollo de la conducta alimentaria es un proceso complejo en el que participan componentes fisiológicos de regulación de la ingesta alimentaria, del crecimiento y peso corporal; componentes psicológicos del niño, de los padres y de la familia y además componentes culturales y sociales. Son frecuentes sus alteraciones en los primeros años de vida, las que se pueden traducir en un retraso del crecimiento, aversiones alimentarias y dificultades secundarias en la convivencia familiar. El manejo de estas alteraciones debiera estar basado principalmente en una educación preventiva en los primeros dos años de vida a la madre, en la modificación conductual del ambiente familiar (madre, hijo, otros miembros de ella) y sólo secundariamente considerar el manejo con fármacos

Anorexia nervosa ou doença celíaca? / Anorexia nervosa or celiac disease

Os sintomas gastrointestinais säo comuns nos transtornos alimentares, o que faz com que se torne difícil o diagnóstico de uma ou de outra entidade clínica. Os autores fazem o relato de caso de uma adolescente de 17 anos de idade, que após um ano de acompanhamento com gastroenterologista foi encaminhada para internaçäo em hospital psiquiátrico com suspeita diagnóstica de anorexia nervosa purgativa. Curiosamente, sua sintomatologia clínica sugeria tratar-se desse diagnóstico: perdeu 25 kg desde o início até a procura de ajuda psiquiátrica; o seu índice de massa corpórea de Quetelet (IMC) era de 12,98 kg/m2, tinha vômitos pós-alimentares. No entanto, tudo sem as manifestaçöes psicopatológicas pertinentes a este transtorno. A observaçäo clínica e os exames complementares realizados (anticorpo antiendomísio e endoscopia digestiva alta com biópsia de segunda porçäo do duodeno) levaram a estabelecer o diagnóstico de doença celíaca (DC), com a paciente recebendo alta hospitalar e sendo encaminhada para acompanhamento em serviço de gastroenterologia. Isso nos adverte para a necessidade de uma investigaçäo minuciosa diante de um quadro de apresentaçäo atípica de transtorno alimentar, para que outras patologias näo sejam negligenciadas e o paciente seja beneficiado com diagnóstico e intervençäo precoces

Abuso sexual, transtornos mentais e doenças fisicas / Sexual abuse, mental disorders and medical illness

Objetivo: revisar e descrever as possiveis repercussoes organicas e psiquicas do abuso sexual. Metodologia: revisao bibliografica por meio do MedLine e do Lilacs de 1987 a 1997 de 71 artigos, alem de 14 livros sobre o assunto. Resultados: o abuso sexual e menos frequente - ou menos relatado - no Brasil. As taxas, no pais, sao de 7 por cento e, nos Estados Unidos, variam amplamente de 12,9 por cento a 28 por cento em mulheres e de 2 por cento a 9 por cento nos homens. Ha maiores taxas de abuso sexual entre as mulheres, mas o abuso fisico parece ocorrer igualmente entre os dois sexos. Os estudos tem...

The human ruminant.

A five-month-old female infant was admitted to the Tropical Metabolism Research Unit with a weight for age of 49% and no evidence of oedema giving rise to a diagnosis of marasmus (Wellcome Classification). The underlying reason for her malnutrition was the Infant Rumination syndrome. This is an uncommon disorder which is thought to have a psychological component. A lack of awareness of the syndrome often leads to delay in diagnosis.

The Human Ruminant

A five-month-old female infant was admitted to the Tropical Metabolism Research Unit with a weight for age of 49 percent and no evidence of oedema giving rise to a diagnosis of marasmus (Wellcome Classification). The underlying reason for her malnutrition was the Infant Rumination syndrome. This is an uncommon disorder which is thought to have a psychological component. A lack of awareness of the syndrome often leads to delay in diagnosis. (AU)

The Human Ruminant

A five-month-old female infant was admitted to the Tropical Metabolism Research Unit with a weight for age of 49 percent and no evidence of oedema giving rise to a diagnosis of marasmus (Wellcome Classification). The underlying reason for her malnutrition was the Infant Rumination syndrome. This is an uncommon disorder which is thought to have a psychological component. A lack of awareness of the syndrome often leads to delay in diagnosis.

Rumination syndrome in adolescents.

OBJECTIVES: To evaluate the clinical presentation and to assess the usefulness of antroduodenal manometry (ADM) and the results of multidisciplinary team management in 12 neurologically normal adolescents (9 girls) with rumination. STUDY DESIGN: All patients had extensive investigations that ruled out other causes of their chronic symptoms. We performed ADM in all patients. A multidisciplinary approach was used for the nutritional and behavioral rehabilitation of these patients. RESULTS: The median age at presentation was 14 years (range, 9-19 years), and the average duration of symptoms was 17 months. All patients complained of postprandial, effortless regurgitation, and the majority had weight loss and abdominal pain. Results of fasting ADM were normal in all. The postprandial ADM showed brief, simultaneous pressure increases at all recording sites, associated with regurgitation in 8 patients. No emesis was observed in the other 4 children during the study. Treatment included nutritional support in combination with antidepressants and anxiolytics (n = 6), cognitive therapy with biofeedback or relaxation techniques (n = 7), and pain management (n = 2). Resolution or improvement of symptoms was seen in 10 of the 12 patients, and successful transition to oral feedings was achieved in all during the follow-up period, which ranged from 5 to 36 months. CONCLUSIONS: Rumination is a distinct functional gastrointestinal disorder of otherwise healthy children and adolescents, which can be diagnosed on the basis of clinical features. The ADM shows a characteristic pattern and rules out motility disorders that are often confused with rumination. A multidisciplinary team approach is associated with satisfactory recovery in most patients.

A história familiar e a obesidade na adolescência: um estudo clínico-qualitativo com adolescentes obesos / Family history and obesity in adolescence: a clinical-qualitative study with obese teenagers

Este trabalho teve como objetivo estudar os aspectos da história familiar do adolescente obeso através da pesquisa qualitativa, tendo em vista maior compreensäo dos fatores desencadeantes e mantenedores da obesidade, propondo-se ampliar a abordagem deste distúrbio alimentar. Para isto usou-se os parâmetros do método clínico-qualitativo e o instrumento de pesquisa foi a entrevista semi-estruturada. Foram entrevistados quatorze adolescentes pertencentes a doze famílias. O tratamento dos dados foi realizado seguindo-se os conceitos da Análise de Conteúdo. Foram definidas quatro categorias temáticas o que permitiu a análise e a discussäo dos seguintes itens: 1)A história familiar do adolescente obeso; 2)A importância da relaçäo mäe-bebê, do processo de individualizaçäo e da funçäo paterna na estruturaçäo do sujeito e suas implicaçöes na obesidade; 3)Sentimentos e concepçöes em relaçäo á obesidade; 4)Demanda do paciente e família (expectativa em relaçäo ao tratamento, motivo de procura).