Challenges implementing recent recommendations of daily formula supplementation for allergy prevention and practical real-world options.

The Canadian Paediatric Society's Position statement 'Dietary exposures and allergy prevention in high-risk infants' December 2021 provides recommendations for regular ingestion of cow's milk protein (CMP) once introduced in early infancy. These recommendations are based on evidence from randomized controlled trials (RCTs) where researchers supported participants in adhering to diet recommendations. Real-life dilemmas that relate to dietary adherence including cost, food wastage, and practicality are not addressed and are the crux of where -evidence-based recommendations fail. This commentary highlights the difficulties in carrying out the proposed recommendation for regular ingestion of CMP in practice and offers three practical real-world options instead.

High adiposity is associated cross-sectionally with low self-concept and body size dissatisfaction among indigenous Cree schoolchildren in Canada.

BACKGROUND: Obesity and mental health problems are prevalent among indigenous children in Canada and the United States. In this cross-sectional study the associations between adiposity and body size satisfaction, body image and self-concept were examined in indigenous children in grades four to six living in Cree communities in the Province of Quebec (Canada). METHODS: Weight status and body mass index (BMI) z-scores were derived from children's measured height and weight using the World Health Organization growth reference. Multivariate regression models that included child's age and sex were used to assess the association between (a) weight status and physical appearance satisfaction using pictorial and verbal body rating measures in 202 of 263 children, and (b) BMI z-score and self-concept measured using the Piers-Harris Children's Self-Concept Scale in a subset of 78 children. RESULTS: Children (10.67 ± 0.98 years) were predominantly overweight (28.2%) or obese (45.0%). Many (40.0%) children had low global self-concept indicating that they had serious doubts about their self-worth and lacked confidence. About one-third (34.7%) of children did not like the way they looked and 46.3% scored low on the physical appearance and attributes domain of self-concept indicating poor self-esteem in relation to their body image and physical strength, feeling unattractive, or being bothered by specific aspects of their physical appearance. Compared to normal weight children, overweight and obese children were more likely to desire being smaller (OR=4.3 and 19.8, respectively), say their body size was too big (OR=7.7 and 30.6, respectively) and not liking the way they looked (OR=2.4 and 7.8, respectively). Higher BMI z-score was associated with lower scores for global self-concept (ß=-1.3), intellectual and school status (ß=-1.5) and physical appearance and attributes (ß=-1.3) indicating negative self-evaluations in these areas. Despite comparable weight status to boys, girls were more likely to have lower scores for global self-concept (ß=-3.8), physical appearance and attributes (ß=-4.2), desiring to be smaller (OR=4.3) and not liking the way they looked (OR=2.3). CONCLUSIONS: The psychosocial correlates of obesity are important considerations for indigenous children, particularly girls, given that poor self-concept and body size dissatisfaction negatively impact mental and emotional qualities of life.

Diabetes awareness and body size perceptions of Cree schoolchildren.

Native American Indians and First Nations are predisposed to obesity and diabetes. A study was done to understand Cree schoolchildren's diabetes awareness and body size perceptions in two communities that had diabetes awareness-raising activities in the Province of Quebec, Canada. Children (N = 203) in grades 4-6 were classified into weight categories using measured heights and weights and grouped on diabetes awareness based on dichotomous responses to the question 'Do you know what diabetes is?' Children selected a drawing of an American Indian child whom they felt most likely to get diabetes and described their body size perception using a closed response question. Although 64.5% of children were overweight or obese, most (60.1%) children considered their body size to be 'just right', with 29.6% considering it 'too big' and 10.3% considering it 'too small'. A minority (27.6%) of children had diabetes awareness. These children were more likely than children without diabetes awareness to consider their body size too big (42.9 versus 24.5%) and to choose an obese drawing as at risk for diabetes (85.7 versus 63.3%, odds ratio 3.48 and 95% confidence interval 1.53-7.91). Culturally appropriate health education programs to increase schoolchildren's diabetes awareness and possibility to have a healthy body weight are important.

Surgical fasting guidelines in children: Are we putting them into practice?

BACKGROUND: Patients are traditionally kept fasting (NPO) from midnight prior to surgery, to prevent aspiration during anesthesia. NPO time is continued postoperatively, out of concern for ileus. Prolonged periods of NPO place the pediatric population at risk for under-nutrition. Published guidelines for preoperative NPO times have been shown to be safe. The aim of this study was to investigate current pre- and postoperative feeding practices of children at a pediatric tertiary care hospital. METHODS: Medical charts were used to extract data prospectively from 53 patients undergoing general, neurosurgical, or urological procedures. Date and time of NPO periods were recorded as well as the physician's postoperative diet orders and diet progression. Surgical procedures were classified as complex or noncomplex by the surgeons. Data were summarized and compared to published recommendations. RESULTS: Preoperative NPO times were greater than recommended in 70% of patients studied (n=37). Median time spent NPO preoperatively was not significantly different between complex (11.5h) and noncomplex groups (10.8h). Postoperative NPO time was significantly greater for complex procedures than for noncomplex. Most patients received some postoperative NPO time, even when it was not included in the physician diet order. CONCLUSION: Observed preoperative NPO time exceeded current recommendations in this study.