Prevalence of malnutrition and risk of under-nutrition in hospitalized children.

BACKGROUND & AIMS: Malnutrition can increase morbidity or mortality and hospitalization may further increase the risk of nutritional deterioration. This study aimed to assess the prevalence of malnutrition and nutritional risk in hospitalized children and to identify any associated factors. METHODS: Nutritional status and risk was defined in 157 hospitalized children using anthropometry and a nutritional risk score (NRS). RESULTS: The frequency of wasted, stunted, overweight and obese children was 4.5%, 8.9%, 15.1% and 10.4% respectively. Half (52.6%) of the undernourished children were aged less than 2 years of age. Forty-eight percent of the overweight or obese children were aged between 10 and 18 years of age. Based on their NRSs, 47.8% of the children assessed were at high risk of nutritional deterioration whereas 28.7% were at no nutritional risk. Children with higher nutritional risk scores had lower weight for age (p=0.02), lower BMI percentiles (p=0.001) and longer hospitalization (p=0.001) than children at no risk. CONCLUSIONS: One quarter of these hospitalized children were overweight or obese. NRSs identified a group of children at increased risk of nutritional deterioration who subsequently had longer hospital stays. Use of NRSs at admission can identify children requiring focused nutritional assessment.

Systematic review: nutritional therapy in paediatric Crohn's disease.

BACKGROUND: At least 25% of individuals diagnosed with Crohn's disease (CD) have onset of disease in childhood. Almost all children with CD have nutritional impairments, such as weight loss or stunting, at diagnosis or subsequently. Nutritional therapy (exclusive enteral nutrition) is established as a valid and effective treatment in paediatric CD. The advantages of this approach are induction of remission and control of inflammatory changes, mucosal healing, positive benefits to growth and overall nutritional status, and avoidance of other medical therapies. AIM: To provide a comprehensive up-to-date review of the roles of nutritional therapy in CD and of the data supporting this therapy. METHODS: A search of PubMed was performed with search terms 'enteral nutrition', 'nutritional therapy', 'Crohn disease' and 'children'. Relevant articles were selected from this search. In addition, the reference lists of available articles were reviewed for further relevant articles. RESULTS: Nutritional therapy offers numerous benefits in the management of CD. Recent work has begun to elucidate the likely mechanisms of this therapy. These include direct mucosal anti-inflammatory effects and alteration of intestinal microflora. CONCLUSION: Further studies are required to define longer-term effects of nutritional therapy in patients with CD.

Childhood inflammatory bowel disease: parental concerns and expectations.

AIM: To document the concerns and expectations of parents of children with inflammatory bowel disease (IBD) within the context of a multidisciplinary IBD clinic, and to highlight the importance of a holistic approach to the care of these children. METHODS: The parents of 60 children with IBD were surveyed by mailed questionnaire. Parents were asked to provide details of their concerns regarding their child's condition and to express their expectations of medical care. In addition, enquiry was made in respect to the respondents' learning about IBD. RESULTS: Forty-six questionnaires (77%) returned. Fifty-two percent of the patients were male. Patients were aged a mean of 10.9 (+/-4.1) years and diagnosed at an average age of 2.1 (+/-1.8) years previously. The most common concerns expressed by the parents related to the side- effects of medications and the future prospects for their child. Overall, parents were satisfied with aspects of care within the IBD clinic but many suggested additional personnel such as counselors or educators should be available. Parents also reported the need for continuing education and easy access to up-to-date information. CONCLUSION: Parents of children and adolescents with IBD have many common concerns regarding their child's condition. On-going attention to holistic care, including psychosocial and educational elements for patients and families, is appropriate in the context of the chronic and unpredictable nature of IBD.

Use of complementary and alternative medicines by children and adolescents with inflammatory bowel disease.

OBJECTIVES: The use of complementary and alternative medicines (CAM) appears increasingly prevalent in children and adolescents. Individuals with chronic illness may have patterns of greater usage. This questionnaire-based study aimed to ascertain the frequency of use by a group of children with proven inflammatory bowel disease (IBD) and to consider the reasons for their use. METHODS: A questionnaire was sent by mail to the parents of patients currently attending a paediatric IBD clinic. Parents were asked to describe their child's usage of alternative and probiotic therapies and to comment on a number of aspects of such therapies. RESULTS: Forty-six (77%) of 60 mailed questionnaires were returned. The mean age of the children was 10.9 (+/- 4.1) years and they were taking an average of 1.7 (+/- 0.8) prescribed medications. Thirty-three (72%) of the children were said by their parents to be having CAM, with four having five or more such therapies (average 2.4 +/- 1.3 agents per child). The most commonly used agents were probiotics (78%) and fish oils (56%). A minority (12%) of respondents reported that their child's CAM was very effective, although many (50%) noted partial benefits. The 13 children who had never used any CAM therapies ('non-users') did not differ from the 'users' in terms of gender, age, disease or duration of disease. As expected, non-users expressed greater concerns about use of CAM and described different attitudes towards such therapies. CONCLUSION: Complementary and alternative medicines, especially probiotic therapies, frequently are administered to children and adolescents with inflammatory bowel disease. Often this appears to be due to parental frustration with managing their child's chronic illness. Practitioners caring for children and adolescents with IBD need to be aware that their patients may be using alternative therapies and adopt an open attitude in this situation.