[Early restrictive feeding disorders: Quantitative assessment of parent/infant feeding interactions]. / Troubles du comportement alimentaire restrictif du nourrisson et du jeune enfant : évaluation quantitative des interactions parent/nourrisson pendant le repas.

INTRODUCTION: Interest in the study of early feeding disorders (FD) has steadily increased during recent decades. During this period, research described the importance of the transactional relationships and the complex interplay between caregiver and child over time. On the basis of the previous studies, our study tried to explore the associations between the characteristics of the parents and the temperamental characteristics of the infants with early FD. GOALS: A first aim of the present study was to show if parental perception of child temperament (including ability for arousal self-regulation) and parental characteristics (emotional and eating attitudes) are associated with early FD. A second aim was to identify emotional/behavioral difficulties in children with early FD by comparing children with a normal development and children with a diagnosed FD, and to investigate whether there are any correlations between parental emotional and feeding characteristics and a child's eating and emotional-behavioral development. A final aim was to explore if feeding conflict is bound to both infant ability for arousal self-regulatation and caregiver emotional status during meals. METHOD: Participants: 58 clinical dyads (children aged 1-36 months) and 60 in the control group participated in the study. The sample of 58 infants and young children and their parents was recruited in a pediatric hospital. They were compared to healthy children recruited in several nurseries. PROCEDURE: all parent-child pairs in the clinical sample were observed in a 20-minute video-recording during a meal using the procedure of the Chatoor Feeding Scale. After the videotaping, parents completed a battery of self-report questionnaires assessing their child's and their own psychological symptom status. MEASURES: Child's malnutrition assessment was based on the Waterlow criteria. The Child Behavior Checklist (CBCL 1½-5) was used to assess a child's emotional/behavioral functioning. The Infant Behavior Questionnaire-Revised (IBQ-R), a widely used parent-report measure of infant temperament, was used to identify the structure of infant temperament. The Eating Attitude Test-40, a self-report symptom inventory, was used to identify concerns with eating and weight in the adult population. The Chatoor Feeding Scale was used to assess mother-child feeding interactions during a meal based on the analysis of the videotaped feeding session. RESULTS: Analyses revealed that children with FD did not have a difficult temperament, especially no disability for arousal of self-regulatation, but their emotional-behavioral functioning is characterized by internalizing problems. Analyses of the EAT-40 showed that mothers of the children diagnosed with FD had significantly higher scores than mothers of the control sample; it means these mothers showed more dysfunctional eating attitudes. In addition, meals were characterized by negative effects in parents in the clinical group. When compared to the control sample, the feeding interactions between children with FD and their parents were characterized by low dyadic reciprocity, high maternal non-contingency, great interactional conflict and struggles with food. However, no significant correlation emerged either between the severity of malnutrition in infants or the conflict during feeding. CONCLUSION: Our study confirms the relations established in previous research. Finally, future longitudinal studies are needed to further clarify and investigate others factors that may be involved in early feeding disorders.

[Should the whole population be screened for coeliac disease?]. / Faut-il faire un dépistage systématique de la maladie cœliaque dans la population générale ?

To address the issue of mass screening in coeliac disease strict criteria shall be defined. Principles and practice of screening for disease have been defined 40 years ago by Wilson and Jungner, there are still accurate and applied, specially in France for neonatal screening. Screening the whole population for gluten intolerance is not recommended at this time. Aress with gap in scientific knowledge are identified and further prospective epidemiologic studies are needed. These include the timing of screening, defining the natural history of screening-identified asymptomatic patients, developing tools to predict disease onset and disease remission and the potential risks of screening. At the present time, only identification and testing of high-risks groups is recommended.

Oral manifestations of celiac disease in French children.

Celiac disease (CD) is an immune-mediated systemic disorder caused by ingestion of the gluten found in wheat, rye, and barley. The currently estimated prevalence in children is about 1%. CD is a chronic enteropathy with gastrointestinal manifestations including diarrhea, abdominal distension and weight loss, but extra-intestinal features are increasingly being reported. Dental and oral manifestations such as dental enamel defects (ED), delay in dental eruption, and recurrent aphthous stomatitis (RAS) are well-recognized manifestations of CD. The aim of this study was to compare the frequency of oral manifestations (ED, RAS and delay in dental eruption) on deciduous and permanent teeth between children with CD and a control population. An oral examination was performed on 28 CD children and 59 control children. All children were younger than 12 years old and had deciduous or mixed dentition. CD children had significantly more ED and RAS than the control group (67.9% vs. 33.9% P=0.004 and 50.0% vs. 21.8% P=0.011, respectively). No delay in dental eruption was observed in CD children. ED were mainly grade I and II of Aine's classification (color defects and slight structural defects). ED were more often seen on CD children's deciduous teeth than on permanent teeth (57.1% and 13.6%, respectively; P<0.001). The main teeth affected by ED are the second molar and canines of the deciduous teeth, and the first molar, central incisor, and lateral incisors of the permanent teeth. RAS and ED that were symmetrical in all quadrants and occurred firstly in teeth that mineralize during the first year of life both seem to be signs of CD. Thus, more information for dentists and pediatricians on these oral manifestations should help improve detection of CD.

[Survey about the perception of the gastroenteritis and the infection due to rotavirus by the mothers in France]. / Enquête sur la perception de la gastro-entérite et de l'infection à Rotavirus par les mères en France.

AIM: To describe the perception of the acute gastroenteritis (AGE) and the interest for the vaccination of the AGE due to Rotavirus. MATERIAL AND METHODS: Observational investigation realized by phone by the IPSOS institute, with 1002 French women of 18 years and more, constituting a representative national sample, having at least a child below 2 years, between 7 and January 31st, 2008. RESULTS: AGE is mainly considered by the mothers questioned as a grave pathology (43.1%) or very grave (51.3%) for the children below 2 years. This perception is bound to the symptoms and to the complications known for the disease. For the questioned mothers, the AGE comes along very often or often with diarrheas (97.2%), vomits (94.3%) or dehydration (94%). Hospitalizations are also perceived as frequent. The quasi-totality of the questioned women (98.3%) considers finally that it is about a very contagious disease (75.4%) or rather contagious (22.8%). The AGE at the child below 2 years provoke very frequently a medical consultation (91.8%), during which some solutions of oral rehydration are prescribed in six cases on 10 (62%). The questioned mothers are for the greater part favorable (86.3%) to a drinkable vaccine to prevent the AGE due to Rotavirus, and 88.1% say that they would intend to protect their child with this vaccine. CONCLUSION: The questioned mothers know the potential gravity of the AGE and a very wide majority of them (86.3%) declare themselves favorable to the prevention of the AGE at Rotavirus by the vaccination.

Negative influence of maternal smoking during pregnancy on infant outcomes.

BACKGROUND: According to the INPES 2014 health barometer, the prevalence of smoking in pregnant women in France is the highest in Europe : 17.8% of expectant mothers who smoke continue to do so during pregnancy. Several epidemiological studies have confirmed multiple risks for tobacco-exposed infants (low birth weight; digestive, respiratory, neurological, and psychological disorders; obesity; type 1 diabetes). PURPOSE: This study compared a cohort of infants exposed to tobacco in utero (T+) with those unexposed (T-). Birth weight, diet, presence of colic (ROME III criteria) and regurgitations (Vandenplas scale) were specifically analyzed. METHODS: This observational, cross-sectional, and multicenter survey was conducted in France by pediatricians and general practitioners from September 2016 to February 2017. Infants with a chronic pathology and those with parents under 18 years of age were excluded. The data were collected by the physician and by the mother through a self-administered questionnaire. RESULTS: A total of 452 physicians recruited 759 T+ and 741 T- infants in the study. The mean birth weight of T+ infants was significantly lower (3.1±0.5 kg [WHO z-score -0.476±1.081]) than that of T- infants (3.3±0.5 kg [0.033±0.965]; P<0.001). At the time of leaving the maternity facility, 47.7% of T+ infants were breastfed by their mother compared with 70.1% of T- infants. The median reported duration of breastfeeding was 1 month vs. 2 months for T+ and T- infants, respectively. Colic was significantly more common in T+ than in T- infants: 25.6% vs. 12.3% according to the ROME III criteria, and 45.7% vs. 29.7% according to the doctor's opinion (P<0.001 for both). In the T+ group, cases of regurgitation (63.6% vs. 56.5%; P=0.005), respiratory disorder (6.3% vs. 2.4%, P<0.001), and bronchiolitis (6.5% vs. 3.0%; P=0.001) were also more frequent. CONCLUSION: This study confirms that maternal smoking during pregnancy is associated with health risks; exposed infants had significantly more digestive/respiratory symptoms and lower birth weight than unexposed infants. Preventive and educational actions need to be further strengthened in the face of this public health problem.

Prevention of relapse by mesalazine (Pentasa) in pediatric Crohn's disease: a multicenter, double-blind, randomized, placebo-controlled trial.

AIM: This study aimed to test the efficacy of mesalazine in maintaining remission in pediatric Crohn's disease (CD) following successful flare-up treatment. METHODS: In this double-blind, randomized, placebo-controlled trial, 122 patients received either mesalazine 50mg/kg per day (n=60) or placebo (n=62) for one year. Treatment allocation was stratified according to flare-up treatment (nutrition or medication alone). Recruitment was carried out over two periods, as the first period's results showed a trend favoring mesalazine. Relapse was defined as a Harvey-Bradshaw score more than or equal to 5. Time to relapse was analyzed using the Cox model. RESULTS: The one-year relapse rate was 57% (n=29) and 63% (n=35) in the mesalazine and placebo groups, respectively. We demonstrated a twofold lower relapse risk (P<0.02) in patients taking mesalazine in the medication stratum (first recruitment period), and a twofold higher risk in patients taking mesalazine in the nutrition stratum (second recruitment period), compared with the other groups. None of the children's characteristics, which differed across the two recruitment periods, accounted for the between-period variation in mesalazine efficacy. One serious adverse event was reported in each treatment group. CONCLUSION: Overall, mesalazine does not appear to be an effective maintenance treatment in pediatric CD.

[Ingestion of foreign bodies in children. Recommendations of the French-Speaking Group of Pediatric Hepatology, Gastroenterology and Nutrition]. / Ingestion de corps étrangers chez l'enfant. Recommandations du Groupe francophone d'hépatologie, gastroentérologie et nutrition pédiatriques.

Ingestion of foreign bodies is a common pediatric problem. The majority of ingested foreign bodies pass spontaneously. Management of foreign body ingestions varies based upon the object ingested, its location, and the patient's age and past history. Esophageal foreign bodies should be urgently removed because of their potential to cause complications. Ingested batteries that lodge in the esophagus, sharp or pointed foreign bodies in the esophageal or gastric tract, and ingestion of multiple magnets all require urgent endoscopic removal. Flexible endoscopy is the therapeutic modality of choice for most patients. The use of devices such as a latex protector hood or an overtube may facilitate safer extraction of sharp objects.

[Treatment of children with feeding disorders]. / Prise en charge des enfants présentant un refus d'alimentation.

The treatment of children presenting a refusal of feeding is multidisciplinary. This is why the point of view of various speakers were approached at the time of this round table. The gastroenterologists -pediatrician stressed the importance of the clinical data to support the diagnosis of a possible organic pathology and to evaluate the nutritional state. When the denutrition is proven, it is sometimes necessary to have recourse to an artificial enteral feeding. If this one must be prolonged a gastrostomy is preferred. The psychiatrics pointed out the oropharyngeal psychopathologies related to the various feeding disorders met during the childhood, including anorexia, the type of treatment being specific to each nosologic entity. The parent-child's observation in interaction is of primary importance for the diagnosis. The speech therapists evoked the importance of the knowledge of the various stages of maturation of the swallowing and the sensory character of this act to understand the bases of rehabilitation. This rehabilitation is long and does not have to neglect relational dynamics.

[Viral acute diarrhea: clinical and evolutive aspects]. / Diarrhées aiguës virales: aspects cliniques et évolutifs.

The molecular characterization of gastroenteritis viruses has led to advances both in our understanding of the pathogens themselves and in development of a new generation of diagnostics. In developing countries, gastroenteritis is a common cause of death in children under 5 years that can be linked to a wide variety of pathogens. In developed countries, while deaths from diarrhoea are less common, much illness leads to hospitalization or doctor visits. Much of the gastroenteritis in children is caused by viruses belonging to four distinct families: rotaviruses, caliciviruses, astroviruses and adenoviruses. Viral gastroenteritis occurs with two epidemiologic patterns, diarrhoea that is endemic in children and outbreaks that affect people of all ages. Rotavirus infection causes severe gastroenteritis, particularly in infants under six months of age.

[Rotavirus vaccination in France: recommendations of the French Speaking Group of Pediatric Gastroenterology, Hepatology and Nutrition]. / La vaccination rotavirus en France: position du Groupe Francophone d'Hépatologie, Gastroentérologie et Nutrition Pédiatriques.

The rotavirus is the major cause of infantile gastroenteritis worldwide. In Europe and in industrialized countries, rotavirus infections bring out considerable economic expenses. In France, the burden of health expenses is particularly marked during winter period, the peak of rotavirus infections coinciding with that of the respiratory syncitial virus bronchiolitis, this specificity results in an increase of nosocomial infections during this period and a saturation of beds in paediatric hospitals. Vaccination likely represents the only efficacious adapted response to rotavirus infections. Two vaccines have recently been developed and licensed in France. The development of these two vaccines has followed two different strategies. Despite their differences, these vaccines are both safe and efficient in protecting young infants against severe rotavirus acute gastroenteritis. French Health Authorities decided to postpone rotavirus vaccination for at least two years. According scientific and economic data, the French Speaking Group of Gastroenterology Hepatology and Nutrition disagrees with this decision and states that rotavirus vaccination is universally recommended for healthy infants under six months.

[Causes of iron deficiency in children]. / Causes des déficits en fer chez l'enfant.

Iron deficiency and iron deficiency anemia are common conditions worldwide affecting especially children. In developing countries, iron deficiency is caused by poor iron intake and parasitic infection. Poor iron intake linked to inadequate diets, low iron intestinal absorption, chronic blood losses and increased requirements are common causes in high-income countries.

[Feeding disorders in infants and toddlers: At-risk situations and predisposing factors]. / Troubles du comportement alimentaire restrictifs du nourrisson et du jeune enfant : situations à risque et facteurs favorisants.

Feeding disorders and food refusal can be found in 25% of infants, with a minority of them having an organic explanation. Failure to thrive and/or severe malnutrition are found in 3-5% of infants in this population. The objective of this study was to analyze the risk factors of feeding disorders in infants and children less than 3 years of age. This study was conducted from January 2011 to December 2014 and included 103 children, 57 with feeding and/or eating disorders and 46 healthy children considered to be normal eaters. Parents participated in a structured interview and completed a data sheet to record the mode of delivery, neonatal status, medical history, milk feeding, and medical treatment. Statistical analysis indicated that cesarean delivery, prematurity, neonatal diseases, history of eating disorders in the family, consumption of protein hydrolysates, and treatment with proton pump inhibitors were highly significant risk factors in children with eating disorders. In the present study, we showed that several prenatal and postnatal conditions or interventions were associated with the development of eating disorders in young children. Recommendations for future studies include identifying environmental risk factors and implementing prevention programs focused on family, caregivers, as well as healthcare professionals. The objective is to allow physicians to efficiently sort out the wide variety of conditions, categorize them for therapy, and when necessary refer patients to specialists in the field.

[Magnet ingestions in children: a French multicenter study]. / Ingestion de corps étrangers aimantés chez l'enfant: enquête multicentrique française.

Digestive complications related to the ingestion of magnetic foreign bodies in children are increasing, especially in Asia and North America. In France, several case reports have been reported since 2008. We conducted a retrospective multicentric study to evaluate the frequency of ingestion of magnet foreign bodies and to describe the complicated cases that have occurred in France over the last 5 years. We report 40 cases of which 60% were multiple magnet ingestions. Eighty-eight percent of the children of the group who had swallowed multiple magnets needed interventional management by endoscopy (33%) or surgery (58%). Only two children (12.5%) of the group who swallowed one magnet required removal. This problem is not uncommon in France (2% of the 1132 foreign bodies investigated in the Toulouse center over 5 years), which justifies clear information for healthcare professionals and caregivers in order to avoid potential intestinal complications. We suggest interventional management or very close monitoring in the cases of multiple magnet ingestion. Meanwhile, in the majority of confirmed cases of simple magnet ingestions, we propose home monitoring.

The toxic fraction of gliadin digests in coeliac disease. Isolation by chromatography on Biogel P-10.

Improvement in the fractionation of gliadin digests and in the isolation of toxic fractions was achieved using chromatography on Biogel P-10. Fraction V, one of the 11 fractions eluted from a peptic-tryptic digest of crude gliadin extracted from Cappelle wheat, significantly affected coeliac jejunal mucosa in organ culture. BV, gamma V, omega V, the corresponding fractions V from beta-, gamma- and omega-gliadins, displayed similar toxic effects. Fraction VI containing peptides with a lower molecular mass did not show any significant cytotoxic activity and, moreover, inhibited the toxicity of fraction V. Analysis of the toxic fractions V showed that they contained peptides of 7-8,000 molecular mass, rich in proline and glutamine and poor in aromatic amino acids and carbohydrates. Among the various fractions, V, beta V from beta-gliadin appeared the less heterogeneous.

Metabolic utilization of linoleic acid from fat emulsion in infants during total parenteral nutrition.

The metabolic utilization of linoleic acid (C18:2w6) from intravenous (iv) soybean oil emulsion via its conversion to higher homologues and prostaglandin biosynthesis was studied in 21 infants. The infants were of normal birth weight, in good clinical and metabolic condition, and aged from 1-4 months. They all received total parenteral nutrition after birth for more than 1 month; the only lipid was provided by iv Intralipid 20%, at levels approximating 350 mg/kg/24 h of linoleic acid (2.5% of the infants' total daily energy intake). Study of the fatty acids of plasma and erythrocyte phospholipids in these infants, compared to healthy controls of the same age (N = 26), showed that 350 mg/kg/24 hr of C18:2w6 supply resulted in normalization of erythrocyte phospholipid fatty acid distribution. This was particularly true of the higher homologues of C18:2w6 (C18:3w6, C20:3w6, and C20:4w6). This suggested that delta 6 and delta 5 desaturation activities are normal in these conditions with this C18:2w6 supply. These results were confirmed by the study of 24-hr urinary excretion of prostaglandins PGE1 and PGE2. With 350 mg/kg/24 hr of C18:2w6 supply their urinary levels were not significantly different from those observed in normal children of the same age receiving an equivalent oral C18:2w6 intake.

Plasma phospholipid fatty acids and urinary excretion of prostaglandins PGE1 and PGE2 in infants during total parenteral nutrition, with continuous or sequential administration of fat emulsion.

During total parenteral nutrition, using an identical supply of fat emulsion (350 mg/kg/24 hr) to correct essential fatty acid deficiency in children, the efficacy of two methods of administration was studied: continuous over 24 hr, or discontinuous 3 hr/day. At the beginning of the study, all the infants (1-4 months old) had proven essential fatty acid deficiency. After at least 1 month of one of the two nutritional protocols (continuous or discontinuous), plasma phospholipid fatty acid composition and PGE1 and PGE2 urinary excretion were measured. The results obtained indicate better utilization of the fat emulsion when it is administered almost every day, in continuous infusion over 24 hr (1 g/kg/24 hr of Intralipid 20%).

[T lymphocyte populations of the intestinal mucosa in celiac disease in children. Immunohistochemical study]. / Populations lymphocytaires T de la muqueuse intestinale au cours de la maladie coeliaque chez l'enfant. Etude immunohistochimique.

In order to study the distribution of lymphocyte subpopulations in a pathologic intestinal mucosa, the authors, instead of using the classic method by counting the number of lymphocytes, present an original method permitting the exploitation of quantified data from labelled surface cells by texture analyser coupled with a computerized system. We investigated 25 children presenting with chronic diarrhea and villous atrophy and 5 control subjects. Fifteen of the 25 children had celiac disease (10 active with total villous atrophy and 5, celiac disease in remission with healing mucosa), 5 cow's milk protein intolerance with total or partial villous atrophy and 5, chronic diarrhea with partial villous atrophy. Immunohistochemical study with monoclonal antibodies was carried out on frozen sections using a three-step immunoperoxidase technique. Compared with the 5 controls, patients with food intolerance (celiac disease and cow's milk protein intolerance) showed a significant increase of T suppressor lymphocytes (p less than 0.01 and p less than 0.05) in the epithelium, whereas there were more T helper lymphocytes in the lamina propria (p less than 0.05 and p less than 0.01). Non-treated celiac disease was distinguished from treated celiac disease by a marked increase in intra-epithelial T cytotoxic-suppressors. These results suggest that T cytotoxic-suppressors may be the mediators of the lesions observed in celiac disease.

[Screening of essential fatty acid deficiency in children. Respective value of the assay of fatty acids in total lipids and lipid fractions of the serum]. / Dépistage d'une carence en acides gras essentiels chez l'enfant. Intérêt respectif du dosage des acides gras dans les lipides totaux et les fractions lipidiques du sérum.

This study was carried out in metabolically stable infants aged from one to six months receiving artificial food. The lipid serum fraction presenting changes characteristic of essential fatty acid (EFA) deficiency was determined. A preliminary study (n = 13 samples) showed that analysis of total fatty acids (TFA) and of phospholipids (PL) was more discriminatory than analysis of free fatty acids (FFA), triglycerides (TG) or esterified cholesterol (EC). Comparison of TFA and PL (n = 25 samples) confirmed literature data; in particular, C18: 2 n-6 and C20: 4 n-6 decreased whereas C20: 3 n-9 increased. These changes were clearer and significantly greater (p less than 0.001) for C20: 3 n-9 and C20: 4 n-6 of the PL, but were also very significant for the TFA compared to healthy controls. The C20: n-9/C20: n-6 ratio was identical for all fractions. TFA analysis by gas-liquid chromatography is faster and less costly than analysis of lipid fractions and provides sufficient data for screening of EFA deficiency.

[Chronic cough and gastroesophageal reflux in children]. / Toux chronique et reflux gastro-oesophagien chez l'enfant.

Gastroesophageal reflux (GER) is one of the three most common causes of chronic cough in children, along with postnasal drip syndrome and asthma. There may be no gastrointestinal symptoms up to 50-75% of the time. GER plays a causative role in chronic cough, asthma without allergy and posterior laryngitis. GER most commonly provokes coughing by stimulating an esophageal-bronchial reflex and by irritating the lower respiratory tract by microaspiration. Twenty-four-hour pH monitoring of the distal esophagus is the most accurate diagnostic method for children with suspected GER and it helps to establish a temporal correlation between cough and GER. The first step of the treatment is the association of postural and dietetic measures and medications (prokinetics and antacids). The length of the treatment is a minimum of 3 months up to the age of walking. Surgical treatment must be reserved for the failure of medical treatment. The benefits of minimally invasive surgery are evident in children with chronic cough, who have a faster recovery with fewer complication than after open surgery.