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Pediatric Nursing Procedure - Artificial Feeding

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Artificial feeding 

Artificial feeding is a form of complementary or substituted feeding given to a baby instead of breast feeding.  

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Parental Obesity Linked to Developmental Delays in Kids

 Source : AAP News and Journals

Parental Obesity and Early Childhood Development

Edwina H. Yeung, Rajeshwari Sundaram, Akhgar Ghassabian, Yunlong Xie, Germaine Buck Louis

Abstract

BACKGROUND: Previous studies identified associations between maternal obesity and childhood neurodevelopment, but few examined paternal obesity despite potentially distinct genetic/epigenetic effects related to developmental programming.

METHODS: Upstate KIDS (2008–2010) recruited mothers from New York State (excluding New York City) at ∼4 months postpartum. Parents completed the Ages and Stages Questionnaire (ASQ) when their children were 4, 8, 12, 18, 24, 30, and 36 months of age corrected for gestation. The ASQ is validated to screen for delays in 5 developmental domains (ie, fine motor, gross motor, communication, personal-social functioning, and problem-solving ability). Analyses included 3759 singletons and 1062 nonrelated twins with ≥1 ASQs returned. Adjusted odds ratios (aORs) and 95% confidence intervals were estimated by using generalized linear mixed models accounting for maternal covariates (ie, age, race, education, insurance, marital status, parity, and pregnancy smoking).

RESULTS: Compared with normal/underweight mothers (BMI <25), children of obese mothers (26% with BMI ≥30) had increased odds of failing the fine motor domain (aOR 1.67; confidence interval 1.12–2.47). The association remained after additional adjustment for paternal BMI (1.67; 1.11–2.52). Paternal obesity (29%) was associated with increased risk of failing the personal-social domain (1.75; 1.13–2.71), albeit attenuated after adjustment for maternal obesity (aOR 1.71; 1.08–2.70). Children whose parents both had BMI ≥35 were likely to additionally fail the problem-solving domain (2.93; 1.09–7.85).

CONCLUSIONS: Findings suggest that maternal and paternal obesity are each associated with specific delays in early childhood development, emphasizing the importance of family information when screening child development.

Abbreviations:

aOR —adjusted odds ratio

ASD —autism spectrum disorder

ASQ —Ages and Stages Questionnaire

CI —confidence interval

GWG —gestational weight gain

OR —odds ratio

 

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Clues to Spotting Thyroid Issues in Kids

A new review article covers the presentation, evaluation, and treatment of thyroid disorders in children and teens. It was published online August 29 in JAMA Pediatrics.

The article is intended to be a one-stop evidence-based review of pediatric thyroid diseases commonly seen in primary care. It covers hypothyroidism, hyperthyroidism, thyroid nodules, and thyroid cancer and provides tools for evaluating these disorders.

"The primary care physician plays a critical role in identifying children and adolescents with thyroid disease," lead author Andrew Bauer, MD, from Children's Hospital of Philadelphia, Pennsylvania, commented to Medscape Medical News.

Dr Bauer formerly practiced general pediatrics before completing an endocrinology fellowship and said he was sensitive to the demands and time pressures of frontline healthcare providers.
He emphasized the importance of early identification and treatment of thyroid disorders, which can affect growth and neurocognitive development.

"An understanding of the risk factors, signs and symptoms, as well as the evaluation and treatment of hypothyroidism and hyperthyroidism, is associated with earlier diagnosis, earlier initiation of treatment, and reduced morbidity from disease," he stressed.

The authors included information from 83 articles identified through a literature search and published between January 2010 and December 2015, along with some earlier articles of historical interest.
It covers basic pathophysiology, clinical presentation, diagnosis (including laboratory and radiologic assessment), and treatment of congenital hypothyroidism, acquired hypothyroidism, hyperthyroidism, and thyroid nodules. The article also lists criteria for selecting which patients should have definitive treatment for Graves disease.

The review points out a key feature in differentiating hypo- and hyperthyroidism from thyroid nodules: The former are often symptomatic at presentation, while the latter often do not have symptoms and are diagnosed incidentally on physical exam.
"Signs and symptoms of acquired thyroid disease include altered growth, goiter, and/or change in behavior or school performance. Patients with thyroid nodules and thyroid cancer are typically asymptomatic at the time of diagnosis," Dr Bauer explained.

Acquired hypothyroidism is most commonly due to an autoimmune disorder (Hashimoto thyroiditis), with a 1% to 2% prevalence in childhood and a 4:1 female-to-male ratio.
Congenital hypothyroidism affects about 1:1500 to 1:3000 infants diagnosed through universal screening as part of the newborn exam. Affected infants are often asymptomatic at birth but may develop symptoms after the first 48 hours of life.
Meanwhile, hyperthyroidism accounts for about 15% of pediatric thyroid disorders, mostly due to autoimmune hyperthyroidism (Graves disease). Hyperthyroidism has a peak incidence at ages 10 to 15 years.

The incidence of thyroid nodules has increased over the past few decades. Most nodules are benign, but those diagnosed before age 19 years have a higher rate of malignancy than those in older patients.
Because children and teens often have enlarged lymph nodes, a working knowledge of the common location of reactive compared with pathologic lymph nodes is important, according to Dr Bauer. Papillary thyroid cancer, the most common form of thyroid cancer, commonly metastasizes to the cervical and lateral neck lymph nodes. Therefore, the authors provide a diagram showing the location of lymph nodes in the neck and which ones to suspect in thyroid cancer.

Dr Bauer also emphasized the importance of a complete thyroid and lymph node exam, which can be conducted in 1 to 2 minutes as part of a well-care visit. He and his coauthors have developed a YouTube video on how to perform a complete thyroid exam in different types of patients, including those with a normal thyroid.

"For patients with persistent lymphadenopathy, thyroid cancer must be included in the differential diagnosis. If a malignancy is being considered, a thyroid and neck ultrasound should be performed prior to referral for diagnostic, excisional lymph node biopsy," he explained.
When possible, patients should be referred to a pediatric thyroid center experienced in pediatric thyroid nodules and cancer, Dr Bauer added.
Because most patients will need long-term or lifelong medical therapy and follow-up, the authors stressed the importance of communication between primary care providers and subspecialists.