Riesgos asociados a la introducción directa de alimentos sólidos en lactantes / Risks associated with the direct introduction of solid food in infants

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Child feeding style is associated with food intake and linear growth in rural Ethiopia.

BACKGROUND: Little is known about mother-child feeding interactions and how this is associated with food intake and linear growth. OBJECTIVE: To characterize mother-child feeding styles and investigate their associations with accepted mouthful and linear growth in west Gojam, rural Ethiopia. SUBJECTS/DESIGN: Two, in-home, meal observations of children aged 12-23 months (n = 100) were video-taped. The number of mouthful accepted was counted and the caregiver/child feeding styles were coded into positive/negative categories of self-feeding, responsive-feeding, active-feeding, social-behavior and distraction. Data on socio-demographic characteristics, child feeding practices, perception about child's overall appetite, and strategies adopted to overcome food refusal were collected through questionnaire-based interviews. Child and mothers' anthropometric measurements were also taken. RESULTS: Stunting was highly prevalent (48%) and the number of mouthful accepted was very low. Offering breastmilk and threatening to harm were the main strategies adopted to overcome food refusal. Although all forms of feeding style were present, active positive feeding style was dominant (90%) and was positively associated with mouthful accepted. Talking with non-feeding partner (64%), and domestic animals (24%) surrounding the feeding place were common distractions of feeding. Feeding was mostly terminated by caregivers (75%), often prematurely. Overall, caregivers of stunted children had poorer complementary- and breast-feeding practices and were less responsive to child's hunger and satiation cues (P < 0.05). Positive responsive feeding behaviors were associated with child's number of mouthful accepted (r = 0.27; P = 0.007) and stunting (r = 0.4; P < 0.001). CONCLUSION: Low complementary food intake in this setting is associated with caregivers' feeding style and stunting. Nutrition interventions that reinforce messages of optimal infant and young child feeding and integrate the promotion of responsive feeding behaviors are needed.

Observed differences in child picky eating behavior between home and childcare locations.

Picky eating (PE) is a common mealtime difficulty that is reported by up to 50% of caregivers. Most of the research to date on PE has focused on parents, even though millions of children also eat meals in home- or center-based childcare settings. Currently, little is known about PE behaviors manifested by the child across the home and childcare settings, or how these behaviors differ between home-based childcare (HBCC) and center-based childcare (CBCC) locations. The objectives of this study were to compare PE behaviors between the child's home and HBCC or CBCC environments, and compare PE behaviors between HBCC and CBCC environments. Children, ages 3-5 years, were recruited from CBCC (n = 26) or HBCC (n = 24) locations. Caregivers and children were videotaped consuming two different lunchtime meals in their home and childcare. Picky eating behaviors were coded from the videos using a codebook created for the study. Observational results showed that children in CBCC displayed more PE behaviors when at home than at childcare, while HBCC children displayed PE behaviors more similarly between the two locations. Thus, interventions to reduce PE behaviors should be personalized for location-specific intervention programs focused on raising healthy eaters across multiple locations.

Infant feeding and child fussy eating: The Generation R Study.

Fussy/picky eating - i.e. consistently avoiding certain foods - is common in childhood and can be worrisome for parents. Repeated exposure to various flavors as occurs in breastmilk and early exposure to complementary feeding may increase food acceptance and thereby decrease fussy eating. This study examines the associations between infant feeding and child fussy eating in 4779 participants of Generation R, a Dutch population-based cohort. Breastfeeding initiation and continuation, and timing of complementary feeding were assessed by questionnaires at 2, 6, and 12 months. The food fussiness scale of the Children's Eating Behaviour Questionnaire was administered at 4 years. Linear regression analyses were performed, adjusted for confounders. Children who were never breastfed did not differ in fussy eating frequency from children breastfed for 6 months or longer. However, children who were breastfed for less than 2 months had a 0.70 points higher food fussiness sum-score (95%CI:0.27; 1.12) than children breastfed for 6 months or longer. An earlier introduction of vegetables was associated with less fussy eating behavior (p-for-trend:0.005). Particularly children who were introduced to vegetables between 4 and 5 months had a 0.60 point lower food fussiness score (95%CI: 1.06;-0.15) than children introduced to vegetables after 6 months. An early introduction to fruits or any solids was not significantly related to fussy eating, although the effect estimates were in the same direction as for introducing vegetables early. Results suggest that breastfeeding does not predict fussy eating. However, introducing vegetables into a child's diet before 5 months might be protective against fussy eating, although future research should account for parents' own fussy eating.

The importance of mealtime structure for reducing child food fussiness.

The aim of this study was to explore how the structure of mealtimes within the family setting is related to children's fussy eating behaviours. Seventy-five mothers of children aged between 2 and 4 years were observed during a typical mealtime at home. The mealtimes were coded to rate mealtime structure and environment as well as the child's eating behaviours (food refusal, difficulty to feed, eating speed, positive and negative vocalisations). Mealtime structure emerged as an important factor which significantly distinguished children with higher compared with lower levels of food fussiness. Children whose mothers ate with their child and ate the same food as their child were observed to refuse fewer foods and were easier to feed compared with children whose mothers did not. During mealtimes where no distractors were used (e.g. no TV, magazines or toys), or where children were allowed some input into food choice and portioning, children were also observed to demonstrate fewer fussy eating behaviours. Findings of this study suggest that it may be important for parents to strike a balance between structured mealtimes, where the family eats together and distractions are minimal, alongside allowing children some autonomy in terms of food choice and intake.

Development of infant oral feeding skills: what do we know?

The hospital discharge of premature infants in neonatal intensive care units is often delayed due to their inability to feed by mouth safely and competently. With immature physiologic functions, infants born prematurely cannot be expected to readily feed by mouth at the equivalent age of a third trimester of gestation as the majority of their term counterparts do. Consequently, it is crucial that health care professionals gain an adequate knowledge of the development of preterm infants' oral feeding skills so as to optimize their safety and competency as they transition to oral feeding. With a greater sensitivity toward their immature skills, we can offer these infants a safer and smoother transition to independent oral feeding than is currently observed. This review article is an overview of the evidence-based research undertaken over the past 2 decades on the development of very-low-birth-weight infants' oral feeding skills. The description of the different functional levels where these infants can encounter hurdles may assist caregivers in identifying a potential cause or causes for their individual patients' oral feeding difficulties.

Guided, internet-based, rumination-focused cognitive behavioural therapy (i-RFCBT) versus a no-intervention control to prevent depression in high-ruminating young adults, along with an adjunct assessment of the feasibility of unguided i-RFCBT, in the REducing Stress and Preventing Depression trial (RESPOND): study protocol for a phase III randomised controlled trial.

BACKGROUND: Depression is a global health challenge. Prevention is highlighted as a priority to reduce its prevalence. Although effective preventive interventions exist, the efficacy and coverage can be improved. One proposed means to increase efficacy is by using interventions to target specific risk factors, such as rumination. Rumination-focused CBT (RFCBT) was developed to specifically target depressive rumination and reduces acute depressive symptoms and relapse for patients with residual depression in a randomised controlled trial. Preliminary findings from a Dutch randomised prevention trial in 251 high-risk 15- to 22-year-old subjects selected with elevated worry and rumination found that both supported internet-RFBCT and group-delivered RFCBT equally reduced depressive symptoms and the onset of depressive cases over a period of 1 year, relative to the no-intervention control. METHODS/DESIGN: A phase III randomised controlled trial following the Medical Research Council (MRC) Complex Interventions Framework will extend a Dutch trial to the United Kingdom, with the addition of diagnostic interviews, primarily to test whether guided internet-RFCBT reduces the onset of depression relative to a no-intervention control. High-risk young adults (aged 18 to 24 years), selected with elevated worry/rumination and recruited through university and internet advertisement, will be randomised to receive either guided internet-RFCBT, supported by clinical psychologists or mental health paraprofessionals, or a no-intervention control. As an adjunct arm, participants are also randomised to unguided internet-RFCBT self-help to provide an initial test of the feasibility and effect size of this intervention. While participants are also randomised to unguided internet-RFCBT, the trial was designed and powered as a phase III trial comparing guided internet-RFCBT versus a no-intervention control. In the comparison between these two arms, the primary outcomes are as follows: a) onset of major depressive episode over a 12-month period, assessed with a Structured Clinical Interview for Diagnosis at 3 months (post-intervention), 6 months and 15 months after randomisation. The following secondary outcomes will be recorded: the incidence of generalized anxiety disorder, symptoms of depression and anxiety, and levels of worry and rumination, measured at baseline and at the same follow-up intervals. In relation to the pilot investigation of unguided internet-RFCBT (the adjunct intervention arm), we will assess the feasibility and acceptability of the data-collection procedures, levels of attrition, effect size and acceptability of the unguided internet-RFCBT intervention. DISCUSSION: Widespread implementation is necessary for effective prevention, suggesting that the internet may be a valuable mode of delivery. Previous research suggests that guided internet-RFCBT reduces incidence rates relative to controls. We are also interested in developing and evaluating an unguided version to potentially increase the availability and reduce the costs. TRIAL REGISTRATION: Current Controlled Trials ISRCTN12683436 . Date of registration: 27 October 2014.

Percepciones, aspiraciones y retos sobre alimentación saludable que tienen las madres de bajo nivel socioeconómico con hijos preescolares de un distrito de Lima metropolitana / Perceptions, aspirations and challenges about healthy eating that have mothers of low socioeconomic status with preschool children in a district of metropolitan Lima

Introducción: Uno de los grandes problemas de salud en los niños es el sobrepeso y obesidad. El preescolar se encuentra todavía al cuidado de una persona adulta, que en la mayoría de las poblaciones con menores recursos económicos es la madre biológica. Objetivo: Comprender las percepciones, las aspiraciones y los retos sobre la alimentación saludable que tienen las madres de bajo nivel socioeconómico con hijos preescolares de un distrito de Lima Metropolitana. Sujetos y métodos. Enfoque cualitativo, se utilizó el método de teoría fundamentada. Participaron 30 madres con hijos en edad preescolar de bajo nivel socio-económico, en 11 entrevistas a profundidad y 4 grupos focales, todas de un Programa No Escolarizado de Educación Inicial de la comunidad Virgen de la Candelaria, perteneciente al distrito de Villa María del Triunfo. Se exploraron las categorías de percepciones, aspiraciones y retos en torno a la alimentación del preescolar. Los datos fueron analizados con el software Atlas.ti v.7, se resumió la información generando categorías para las percepciones, aspiraciones y retos. Resultados: La edad promedio de las madres fue de 30 años, el 56 por ciento tuvieron educación primaria o secundaria incompleta, promedio de estudios 7,9±3,3 años y el gasto diario fue menor a 20 nuevos soles. Las siguientes categorías emergieron sobre percepciones: las formas de preparar los alimentos para los hijos en edad preescolar, mostrando una actitud positiva hacia los métodos de preparación saludable y enfrentar al comportamiento de rechazo del niño a la hora de comer. Las aspiraciones de las madres fueron en relación a la salud y el comer bien. Los retos fueron llegar a cumplir sus aspiraciones, en donde una de las grandes preocupaciones fue afrontar la forma de llegar a que sus hijos alcancen un buen estado nutricional. Conclusiones: Las percepciones sobre alimentación fueron diversas, con aspiraciones y retos para tener niños más saludables, hecho que llevó a conocer...

Introduction: One of the major health problems in children is overweight and obesity. The preschool is still caring for an adult, which in most cases in populations with fewer economic resources is the biological mother, so it is important as perceived feeding, sucking and challenges have. Objective: This study aimed to explore the perceptions, aspirations and challenges of mothers with low socioeconomic status around feeding their children, in a district of Lima. Subjects and methods. Using qualitative methods, we conducted four focus group and 11 depth interviews in Spanish with 30 mothers of preschool-age children from low-income households in Virgen de la Candelaria, district of Villa Maria del Triunfo, Lima, Peru. The method was grounded theory. We analyzed verbatim transcripts using an inductive method of open coding, and themes were established by consensus among authors, information is summarized generating perceptions themes for each category. Results: The mothers mean age was of 30; 87 per cent were from different departments of Peru; 56 per cent had less school education; and all of them had economic availability were less than 20 soles. The following themes around perceptions, aspirations and challenges emerged: perceptions had themes about the ways of preparing food for preschool children, showing a positive attitude towards the preparation methods and address the child's behavior at mealtime. The themes that emerged on the aspirations of mothers were in relation to health and eating well. The challenges were to get to fulfill their aspirations where one of the major concerns faced was how to get your children reach a good nutritional status. Conclusions: This finding increase our understanding of perceptions, aspirations and challenges of mothers of preschoolers, and can help to inform more cultural aspects for effective nutrition interventions.

[Physical activity among growing children]. / Kasvuikäisten liikunta.

Lack of physical activity poses a risk to the health and well-being of growing children, and should also be considered at a medical consultation. According to recommendations, those of 7 to 18 years of age should carry out at least one hour of physical activity daily. Of the Finnish school-aged children, 50% of the elementary school children but only 17% of the secondary school children follow the physical activity recommendations. Some children exercise and play sports in abundance, and in their case it should be especially made sure that the prevention and, when necessary, treatment of exercise-related injuries, overexertion and eating disorders are taken care of.

Parents and prevention: a systematic review of interventions involving parents that aim to prevent body dissatisfaction or eating disorders.

OBJECTIVE: To systematically review the literature on interventions involving parents that aim to prevent body dissatisfaction or eating disorders in children, and provide directions for future research by highlighting current gaps. METHOD: The literature was searched for articles using key concepts: parents, prevention and eating disorders or disordered eating or body dissatisfaction. All English language publications between 1992 and 2013 were searched across a range of academic databases. Studies were reviewed if they: (i) delivered an intervention designed to reduce eating disorders or body dissatisfaction or their risk factors, in children or adolescents; (ii) provided some intervention component for parents; and (iii) included some outcome measure of intervention effectiveness on disordered eating or body dissatisfaction. A scoring matrix based on the Critical Appraisal Skills Program (CASP) screening questions was used to assess each study's sample representativeness, relevance and data quality. RESULTS: From 647 novel records uncovered by the search, 20 separate studies met inclusion criteria. The CASP scoring matrix revealed eight studies provided no relevant data, four relevant and eight highly relevant data on the effects of involving parents in prevention programs. Two of four high-quality studies reported that parental involvement significantly improved child outcomes on measures of body dissatisfaction or disordered eating. DISCUSSION: Although a greater focus on engaging and retaining parents is needed, this review demonstrates that a small number of prevention studies with parents have led to significant reductions in risk of body image and eating problems, and future research is indicated.

Mealtime duration in problem and non-problem eaters.

Young children commonly encounter difficulties at mealtimes, which are important to address early to avoid the maintenance of problematic eating behaviour. Amongst these are drawn-out meals, which some research has associated with more mealtime problems. However, research on meal duration, and therefore guidelines for appropriate meal length, is lacking. This research aimed to compare the meal duration of problem-eaters and controls, and to examine changes to meal length amongst problem-eaters following a parenting intervention. The mealtimes of 96 problem-eaters and 105 controls were examined via parent-report and in-home observations; meal length was also compared amongst problem-eaters who had received intervention and a waitlist control. Meal duration was similar across groups, though problem-eaters engaged in more aversive behaviour and less eating than controls. Observed eating and mealtime behaviour altered following intervention but not duration. Parents who reported meal length as a specific concern had longer meals and reported less successful feeding than those who did not. These results suggest that what is happening during the meal may better distinguish problem-eaters than duration alone.

Policy brief: effective interventions for the prevention of childhood obesity

Excess body fat has both immediate and long-term effects on the health and well-being of children. Childhood obesity is an urgent public health problem in the region and this problem is escalating. To address this matter, this paper was prepared and seeks to answer the following questions: i) what is the current evidence regarding the effectiveness of interventions for preventing obesity in children and adolescents? ii) What are the characteristics of interventions that have proven to be effective? iii) Which program components or design features of efficacious interventions can be applied within the Caribbean context? The purpose of the Policy Brief is to identify the characteristics of interventions that have been evaluated and found to have positive obesity prevention effects, as measured by a reduction or stabilization of BMI or other outcome measures, which may be implemented in the Caribbean Region as effective responses to the burgeoning epidemic. The primary focus of the Brief is on midstream approaches for changing behaviors. Upstream approaches which include broad based public policy action such as laws, regulation and national policies in and of themselves are excluded. The Brief is prepared for decision-makers and program managers with responsibility for developing and implementing nutrition and other health promotion programs for children.

Diseño y validación de las escalas de evaluación del impacto psicológico de sucesos vitales pasados: el papel del pensamiento rumiativo y el crecimiento personal / Design and validation of the scales for the assessment of the psychological impact of past life events: the role of ruminative thought and personal growth

Introducción. El malestar emocional de las personas mayores se relaciona frecuentemente con procesos de rumiación acerca de episodios vitales acaecidos a lo largo de su vida. El tipo de afrontamiento desplegado ante tales episodios podría contribuir a explicar el bienestar emocional actual de las personas mayores: pueden percibir que han crecido personalmente tras el episodio y/o pueden presentar pensamientos rumiativos sobre tales episodios, que generan malestar emocional. Este trabajo describe el desarrollo y análisis de las propiedades psicométricas de las escalas de evaluación del impacto psicológico de sucesos vitales pasados (EEIPSV): la escala de ocurrencia de sucesos vitales (EO), la escala de pensamiento rumiativo (EPR) y la escala de crecimiento personal (ECP). Material y métodos. Participaron 393 personas mayores no institucionalizadas, residentes en la comunidad de Madrid (edad media: 71,5 años; DE: 6,9). Además de las EEIPSV, se evaluaron las variables: sintomatología depresiva, ansiedad, bienestar psicológico, satisfacción con la vida, función física y vitalidad. Resultados. Los resultados del análisis interjueces sugieren la existencia de 2 factores en la EO: sucesos positivos y negativos. Los análisis factoriales confirmatorios respaldan esta estructura bidimensional tanto para la escala EPR como la ECP. Se obtuvieron buenos índices de consistencia interna para cada escala y subescala, así como buenos índices de validez de criterio y convergente. Conclusiones. Tanto el pensamiento rumiativo sobre sucesos vitales pasados como el crecimiento personal se relacionan con el bienestar emocional de las personas mayores. Las EEIPSV presentan buenas propiedades psicométricas que justifican su uso con población mayor(AU)

Introduction. Older people's emotional distress is often related to rumination processes focused on past vital events occurred during their lives. The specific coping strategies displayed to face those events may contribute to explain older adults’ current well-being: they can perceive that they have obtained personal growth after those events and/or they can show a tendency to have intrusive thoughts about those events. This paper describes the development and analysis of the psychometric properties of the Scales for the Assessment of the Psychological Impact of Past Life Events (SAPIPLE): the past life events-occurrence scale (LE-O), ruminative thought scale (LE-R) and personal growth scale (LE-PG). Material and methods. Participants were 393 community dwelling elderly (mean age=71.5 years old; SD=6.9). In addition to the SAPIPLE scales, depressive symptomatology, anxiety, psychological well-being, life satisfaction, physical function and vitality have been assessed. Results. The inter-rater agreement's analysis suggests the presence of two factors in the LE-O: positive and negative vital events. Confirmatory Factor Analysis (CFA) supported this two-dimensional structure for both the LE-R and the LE-PG. Good internal consistency indexes have been obtained for each scale and subscale, as well as good criterion and concurrent validity indexes. Conclusions. Both ruminative thoughts about past life events and personal growth following those events are related to older adults’ current well-being. The SAPIPLE presents good psychometric properties that justify its use for elderly people(AU)

Complementary foods and flavor experiences: setting the foundation.

Increased fruit and vegetable consumption early in life may lead to life-long intake of fruits and vegetables, which in turn may be beneficial for weight control and other health outcomes in later life. Although health officials worldwide recommend delaying solid foods until 6 months of age, younger infants often receive solid food, which may affect later obesity rates. The timing of introduction to solid foods is important both nutritionally and developmentally and may affect acceptance of foods both in infancy and later in life. Infants can clearly discriminate the flavors of different fruits and vegetables. Repeated flavor experiences promote the willingness to eat a variety of foods: infants will consume more of foods that have a familiar flavor and are more accepting of novel flavors if they have experience with flavor variety. Many flavors that the mother either ingests or inhales are transmitted to her milk and/or amniotic fluid. Mothers can help the transition from a diet exclusively of milk or formula to a mixed diet by providing the infant familiar flavors in both milk or formula and solid foods. Exposure to a variety of flavors during and between meals appears to facilitate acceptance of novel foods. Providing novelty in the context of a familiar food might prove to be an optimal combination to progressively accustom infants to a diversity of novel foods. When repeatedly exposing infants to flavors of some vegetables that have bitter tastes, mothers should focus not on infants' facial expressions but on their willingness to eat the food and should continue to provide repeated opportunities to taste the food. Introducing children repeatedly to individual as well as a variety of fruits and vegetables, both within and between meals, might help them be more accepting of fruits and vegetables, which is difficult to enhance beyond toddlerhood.

[The effects of enteral administration of glutamine enriched solution in very low birth weight infants on reducing the symptoms of feeding intolerance. A prospective, randomized pilot study]. / Wplyw enteralnej podazy roztworu wzbogaconego glutamina u noworodkow z bardzo mala urodzeniowa masa ciala, na ograniczenie objawow nietolerancji karmiena. Prospektywne, randomizowane badanie pilotazowe.

BACKGROUND: Feeding intolerance frequently occurs during the first several weeks of life in very low birth weight infants and may require the reduction of oral feeding. When significantly expressed, it may lead to the development of necrotizing enterocolitis. Apart from breast milk, also the maintenance of normal peristalsis, enterocyte nourishment and keeping a low pH value in the stomach seem to be important points in the NEC prophylaxis. AIM: The authors present the results of the randomized pilot study, performed in two, differently fed groups of VLBW newborns. The aim of the study was to compare the frequency of feeding intolerance, necrotizing enterocolitis, sepsis caused by Gram negative bacteria, intestinal perforation and the number of deaths between the study group and the control group of newborns. MATERIALS AND METHODS: 106 VLBW newborns were qualified for research. In the study group (50 newborns), apart from the mother's milk or preterm formula, infants were enteraly receiving a glutamine/ amino acid solution, the osmolality of which was comparable to amniotic fluid. The pH value of the solution was 5.5 so as to lower acidity of the stomach fluids. In the control group (56 newborns) infants were fed enteraly exclusively with the mother's milk or preterm formula. The patients in the two groups were comparable with regard to birth weight, gestational age, Apgar score and CRIB score, and the frequency of antenatal corticosteroid administration. RESULTS: There was a significantly lower risk of feeding intolerance in infants who were receiving the glutamine/amino acid solution (p=0.015). Also there was a lower risk of NEC (5 vs 10 cases), intestinal perforation (1 vs 4 cases), sepsis caused by Gram negative bacteria (1 vs 4 cases) and death (1 vs 3) in the study group. However, none of these differences reached statistical significance. CONCLUSIONS: Enteral supplementation of glutamine/amino acid solution given simultaneously with enteral feeding is safe and may significantly reduce feeding intolerance in very low birth weight infants in their first days or weeks of life. The results of our research can be useful when attempting to work out the principles of NEC prophylaxis by means of maintaining normal peristalsis, enterocyte nourishment and keeping a low pH value in the stomach.

Influences of disordered eating in prepubescent children.

Research has indicated that children as young as age 5 begin to demonstrate preoccupation with body image and weight, with the desire to be thin. Much of this preoccupation is influenced by increased public awareness of the obesity epidemic, which in turn has placed extreme pressures on school-age children, often leading to prejudices about shape and weight. This negative interaction can lead to a fear of being fat and gaining weight that develops into low self-esteem and eating disorders. An extensive amount of research has investigated the influences of eating disorders among adolescent children, but little has covered this health threat involving prepubescent children. This article explores the relationship between eating disorders, prepubescent children, and various influences.

Feeding difficulties in children and adolescents with chronic illness.

Good health demands good nutrition and in the child it is reflected in normal growth. Children who cannot or do not eat properly often become unwell and do not grow. This becomes a source of great concern and anxiety for their parents. Several chronic illnesses in children impair normal feeding; this article aims to describe the interrelationship between eating and disease in children with reference to some common conditions. The effects of childhood eating disorders on parents and families will also be considered.