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Ailmemts & Remedies Pediatric

Feeding Problems

Definition:
Feeding problem of infancy or early childhood is characterized by the failure of an infant or child under six years of age to eat enough food to gain weight and grow normally over a period of one month or more. The disorder can also be characterized by the loss of a significant amount of weight over one month. Feeding disorder is similar to failure to thrive, except that no medical or physiological condition can explain the low food intake or lack of growth.
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Infants and children with a feeding disorder fail to grow adequately, or even lose weight with no underlying medical explanation. They do not eat enough energy or nutrients to support growth and may be irritable or apathetic. Factors that contribute to development of a feeding disorder include lack of nurturing, failure to read the child’s hunger and satiety cues accurately, poverty, or parental mental illness. Successful treatment involves dietary, behavioral, social, and psychological intervention by a multidisciplinary

Feeding problems are common throughout childhood and affect both boys and girls.

Causes:
The kind of feeding problem may depend on the age of the child.

Some new mothers take a while to get the hang of breastfeeding and may worry they’re not producing sufficient milk or their baby isn’t satisfied. But as long as the baby is gaining weight at the normal rate, there’s no need for concern.

Occasionally, early feeding problems are due to anatomical difficulties (for example, a severe cleft palate or oesophageal atresia) or more general illness, but these are usually quickly identified.

Minor infections, such as a cold, can interrupt established feeding patterns, but rarely for long.

Gastro-oesophageal reflux disease (GORD) can also make feeding difficult, affect weight gain and cause great stress for parents.

More serious conditions can interfere with the absorption of food and weight gain, including coeliac disease, cystic fibrosis, inflammatory bowel disease and food intolerance.

In toddlers and older children, emotional and social factors can cause feeding problems. Older children, especially girls, are more likely to develop eating disorders such as anorexia nervosa and bulimia.

Symptoms:
The symptoms of feeding disorders can vary, but common symptoms include:

•Refusing food
•Lack of appetite
•Colic
•Crying before or after food
•Failing to gain weight normally
•Regurgitating or vomiting
•Diarrhoea
•Abdominal pain
•Constipation
•Behavioural problems

Diagnosis :
Between 25% and 35% of normal children experience minor feeding problems. In infants born prematurely, 40% to 70% experience some type of feeding problem. For a child to be diagnosed with feeding disorder of infancy or early childhood, the disorder must be severe enough to affect growth for a significant period of time. Generally, growth failure is considered to be below the fifth percentile of weight and height.

Feeding disorder of infancy or early childhood is diagnosed if all four of the following criteria are present:

•Failure to eat adequately over one month or more, with resultant weight loss or failure to gain weight.
•Inadequate eating and lack of growth not explained by any general medical or physiological condition, such as gastrointestinal problems, nervous system abnormalities, or anatomical deformations.
•The feeding disorder cannot be better explained by lack of food or by another mental disorder, such as rumination disorder.
•The inadequate eating and weight loss or failure to gain weight occurs before the age of six years. If feeding behavior or weight gain improves when another person feeds and cares for the child, the existence of a true feeding disorder, rather than some underlying medical condition, is more likely.

Treatments :-
Successful treatment of feeding disorders requires a multidisciplinary team approach to assess the child’s needs and to provide recommendations and education to improve feeding skills, behavior, and nutrient intake. The multidisciplinary team for treatment of feeding disorders in childhood usually includes physicians specializing in problems of the gastrointestinal tract or of the ear, nose, and throat; a dietitian, a psychologist , a speech pathologist, and an occupational therapist. Support from social workers and physicians in related areas of medicine is also helpful.

An initial evaluation should focus on feeding history, including detailed information on type and timing of food intake, feeding position, meal duration, energy and nutrient intake, and behavioral and parental factors that influence the feeding experience. Actual observation of a feeding session can give valuable insight into the cause of the feeding disorder and appropriate treatments. A medical examination should also be conducted to rule out any potential medical problems or physical causes of the feeding disorder.

After a thorough history is taken and assessment completed, dietary and behavioral therapy is started. The goal of diet therapy is to gradually increase energy and nutrient intake as tolerated by the child to allow for catch up growth. Depending on the diet history, energy and nutrient content of the diet may be kept lower initially to avoid vomiting and diarrhea. As the infant or child is able to tolerate more food, energy and nutrient intake is gradually increased over a period of one to two weeks, or more. Eventually, the diet should provide about 50% more than normal nutritional needs of infants or children of similar age and size.

Behavioral therapy can help the parent and child overcome conditioned feeding problems and food aversions. Parents must be educated to recognize their child’s hunger and satiety cues accurately and to promote a pleasant, positive feeding environment. Changing the texture of foods, the pace and timing of feedings, the position of the body, and even feeding utensils can help the child overcome aversions to eating. If poverty, abuse, or parental mental illness contribute to the feeding disorder, these issues must also be addressed.

Prognosis :-
If left untreated, infants and children with feeding disorders can have permanent physical, mental, and behavioral damage. However, most children with feeding disorders show significant improvements after treatment, particularly if the child and parent receive intensive nutritional, psychological, and social intervention.

Prevention :-
Providing balanced, age-appropriate foods at regular intervals—for example, three meals and two or three snacks daily for toddlers—can help to establish healthy eating patterns. If a child is allowed to fill up on soft drinks, juice, chips, or other snacks prior to meals, appetite for other, more nutritious foods will decrease.

Positive infant and childhood feeding experiences require the child to communicate hunger and satiety effectively and the parent or caregiver to interpret these signals accurately. This set of events requires a nurturing environment and an attentive, caring adult. Efforts should be made to establish feeding as a positive, pleasant experience. Further, forcing a child to eat or punishing a child for not eating should be avoided.

You may click to see :

*Feeding Problems in Infants and Children
*Problems feeding your baby?

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/feedingproblems2.shtml
http://www.minddisorders.com/Del-Fi/Feeding-disorder-of-infancy-or-early-childhood.html

http://www.brighttomorrowstoday.com/behavior-feeding-therapy.html

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News on Health & Science

Irregular Sleep Makes You Obese

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People who sleep fewer than six hours a night – or more than nine – are more likely to be obese, according to a new government study that is one of the largest to show a link between irregular sleep and big bellies.

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The study also linked light sleepers to higher smoking rates, less physical activity and more alcohol use.

The research adds weight to a stream of studies that have found obesity and other health problems in those who don’t get proper shuteye, said Dr Ron Kramer, a Colorado physician and a spokesman for the American Academy of Sleep Medicine.

“The data is all coming together that short sleepers and long sleepers don’t do so well,” Kramer said.

The study released Wednesday is based on door-to-door surveys of 87,000 US adults from 2004 through 2006 conducted by the National Centre for Health Statistics, part of the Centres for Disease Control and Prevention.

Such surveys can’t prove cause-effect relationships, so – for example – it’s not clear if smoking causes sleeplessness or if sleeplessness prompts smoking, said Charlotte Schoenborn, the study’s lead author.

It also did not account for the influence of other factors, such as depression, which can contribute to heavy eating, smoking, sleeplessness and other problems.

Smoking was highest for people who got under six hours of sleep, with 31 per cent saying they were current smokers. Those who got nine or more hours also were big puffers, with 26 per cent smoking.

The overall US smoking rate is about 21 per cent. For those in the study who sleep seven to eight hours, the rate was lower, at 18 per cent.

Results were similar, though a bit less dramatic, for obesity: About 33 per cent of those who slept less than six hours were obese, and 26 per cent for those who got nine or more. Normal sleepers were the thinnest group, with obesity at 22 per cent.

For alcohol use, those who slept the least were the biggest drinkers. However, alcohol use for those who slept seven to eight hours and those who slept nine hours or more was similar.

In another measure, nearly half of those who slept nine hours or more each night were physically inactive in their leisure time, which was worse even than the lightest sleepers and the proper sleepers. Many of those who sleep nine hours or more may have serious health problems that make exercise difficult.

Many elderly people are in the group who get the least sleep, which would help explain why physical activity rates are low. Those skimpy sleepers who are younger may still feel too tired to exercise, experts said.

Stress or psychological problems may explain what’s going on with some of the lighter sleepers, experts said.

Other studies have found inadequate sleep is tied to appetite-influencing hormone imbalances and a higher incidence of diabetes and high blood pressure, noted James Gangwisch, a respected Columbia University sleep researcher.

“We’re getting to the point that they may start recommending getting enough sleep as a standard approach to weight loss and the prevention of obesity,” said Gangwisch, who was not involved in the study.

You may click to see also:->Less Sleep = Fatter

Men Skipping Sleep Turn Obese

Sources: The Times Of India

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News on Health & Science

Getting a Grip on the Winter Blues (SAD)

It is that time of year again, when despite the ratcheting up of festivities for the holidays, fully one person in five in the United States ratchets down. The cause is a now well-known but still infrequently treated disorder, winter blues or SAD, for seasonal affective disorder.

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There are several remedies to help those affected by SAD escape an affliction that leaves many wanting to climb into bed, put their heads under the covers and not come out until spring. Indeed, some experts refer to SAD as a form of hibernation.

The problem typically starts gradually as the days become shorter in late summer or fall and peaks in midwinter in regions where there may be just 9 or 10 hours of daylight, if that.

For the estimated 14 million severely affected American adults, SAD can send them into a tailspin that makes it difficult if not impossible to fulfill daily responsibilities and derive any joy from life. An additional 33 million people are less severely affected but may experience declines in energy, cheerfulness, creativity or productivity in the dark days of winter.

The most commonly used treatment is exposure for up to several hours a day to high-intensity artificial light, in an effort to simulate the longer days of summer when people with SAD function at top speed.

Jet Lag and Circadian Rhythm
Dr Alfred J. Lewy, a psychiatrist who has been studying the biology behind SAD, describes it as a form of jet lag, a concept he proposed 20 years ago. He recently published experimental evidence that he says attests to the validity of this theory. If true, this would make SAD a disturbance in the circadian rhythm, the 24-hour pattern that normally aligns the sleep-wake cycle with all the other bodily rhythms. Dr. Lewy suggests that with the delayed dawn and shorter days of fall and winter, the rhythms of people afflicted with SAD drift out of phase with the sleep-wake cycle, as if they had traveled across many time zones.

With jet lag, recovery occurs over a matter of days, and the circadian rhythm once again becomes synchronized with day and night. “In people with SAD, this adjustment takes five months,” Dr. Lewy said.

If his theory is substantiated by further research, it may one day be possible to treat SAD with tiny daily doses of time-released melatonin, the substance in the brain that regulates the sleep-wake cycle. Melatonin naturally increases in the evening, causing sleepiness, and falls off as morning approaches. The idea would be to tailor the administration of melatonin in a way that realigns the out-of-sync circadian rhythm in people with SAD, just as tiny doses (much smaller than those typically sold in health-food and drug stores) of melatonin can be used to speed recovery from jet lag.

In his study, conducted with three colleagues at Oregon Health Sciences University, Dr. Lewy identified two types of SAD patients. About two-thirds required morning light or evening melatonin to correct their body clocks. The remainder needed evening light or morning melatonin to put their body rhythms back on track. Currently, there is no commercial source of time-release low-dose melatonin that could be used, with or without light therapy, to help people with SAD.

Current Remedies
Dr. Norman E. Rosenthal, a native of South Africa who discovered his own serious problem with SAD while a resident in psychiatry at the New York State Psychiatric Institute in 1976, has become an expert in diagnosing and treating the problem. His knowledge and experience in helping himself and countless patients afflicted with SAD are summarized in “Winter Blues: Everything You Need to Know to Beat Seasonal Affective Disorder,” whose revised edition the Guilford Press published this year.

Dr. Rosenthal aptly describes SAD as “an energy crisis.” Patients are not depressed in the usual emotional sense, but rather feel as if their batteries have run down.

The symptoms of SAD do mimic those of serious depression. Patients say they have to drag themselves out of bed in the morning, even after 10 hours of sleep, and force themselves to perform necessary chores. They feel leaden and would just as soon not see anybody or do anything. They find it difficult to concentrate and think clearly and quickly.

Sex drive often dwindles markedly but is often replaced by an insatiable appetite for carbohydrates — breads, pasta, potatoes, rice and sweets — that results in weight gain. Many people with SAD have two wardrobes, the one for winter being two sizes larger.

The most common remedy is light therapy. But not just any light. Patients are advised to sit in front of a specially designed light box that emits about 10,000 lux from a fluorescent bulb, most often in the morning for at least 45 minutes. Some patients require hours of light therapy each day to ward off the symptoms of SAD, which may mean having one light box at home and a second at work.

Among commercial sources for these light boxes is the Center for Environmental Therapeutics, which sells them for $200. Its Web site, www.cet.org, is a useful source of information about SAD.

Among other light-enhancing suggestions from Dr. Rosenthal are planning a winter vacation in a sunny climate or relocating to someplace nearer the Equator, where the days are longer in winter. (But, he cautions, first be sure you can tolerate the summer there.)

Helpful Machines and Therapies
For those who remain in northern latitudes, Michael and Jiuan Su Terman of the New York State Psychiatric Institute at Columbia University, who have conducted pioneering studies of SAD remedies, suggest considering a “dawn simulator.” This device gradually turns on a bedroom light every morning while you are still asleep, helping ease SAD symptoms by making the body think that it is experiencing the early sunrises of summer.

This might also help people who do not have SAD but who hate getting up in the morning when it is still dark out.

The Termans have also found another helpful gadget, a negative-ion generator. They showed that sitting in front of a machine that emits negative ions at a high rate for 30 minutes every morning was as effective as sitting in front of a light box for the same time. The generators are available for $165 from the Center for Environmental Therapeutics (Michael Terman is the president of its board). The advantage of this device is that it can be used while sleeping.

A third approach that has proved effective is cognitive behavioral therapy, when used with or without light therapy. Kelly J. Rohan of the Uniformed Services University of the Health Sciences in Bethesda, Md., (and currently of the University of Vermont) found that this therapy, a brief form of psychotherapy that helps people change negative thoughts and behaviors, was as effective as light therapy in a study of 23 patients with SAD.

And unlike light therapy used alone, cognitive behavioral therapy helped prevent a relapse of SAD symptoms the next winter.

Dr. Rosenthal also recommends eating a diet relatively high in protein and low in carbohydrates and performing regular physical exercise, which is especially helpful if it is outdoors in the morning or, if indoors, in front of a light box.

Source:The New York Times