children | MY SPECIAL DOCTOR

Children and boredom

26 February 20246 January 2024 by marisadarrigo

Our lives (and those of our children) seem to respond to a kind of categorical imperative“no boredom.” We are constantly seeking new stimulation and our lifestyle has outlawed downtime and empty space. This dimension, already problematic for adults, is infinitely more so for children because it runs the risk of preventing the development of a number of structuring functions of psychic organization.

The positive side of boredom

When a child is bored, that is, when he or she experiences a moment of absence of stimulation from outside (whether it is someone to play with or a new game or whatsApp contact), he or she definitely feels lost and without an anchor (in fact, he or she usually becomes whiny and….just boring). But it is only from this condition of emptiness that he can draw on himself, his resources and in particular his imagination. This means not only activating one’s creativity, that is, the ability to create parallel universes within which to move and build paths of play and imagination, but it also means acquiring self-regulation skills (understood as self-consolation, tolerance and overcoming frustration).

I think they are part of every adult’s memory of those long summer afternoons in which, not knowing what to do, one would wearily dawdle until one’s attention was caught by some hitherto insignificant object or by the line of ants proceeding up the wall or by the figures in a publication. A spark had been ignited made of imagination, observation, curiosity. Experiencing that you can do it, that you can create for yourself a hook of interest and attention, means freeing yourself from a condition of dependence on a reality that seems to have to constantly offer new and greater stimuli (more and more games, more and more lights, more and more sounds, etc.).

Certainly it is the responsibility of parents and educators in general stimulate children, provide them with opportunities for experiences, learning and fun, but this not only cannot be done seamlessly but should also be limited to drawing the lines, leaving children to define and invent the content . Giving an idea, an impetus, a rule but not organizing time, play or relationship. They do not need to be busy all the time.

One would be inclined to say “Ode to Boredom.” Let them be bored, dangle and be a bit boring, observe them, e will find that they have unhoped-for resources. We will give them an ability that will be theirs forever.

The approach to pain in the child

25 February 20246 January 2024 by psalari

How should we react when our little one complains of some kind of physical pain? The wise and recommended thing to do is to consult your pediatrician before giving your little one any kind of medicine. First, the pediatrician needs to acquire some information to understand the type and extent of the pain, and it is therefore good for parents (if the child is not yet able to express himself) to prepare to respond. He himself will recommend the most appropriate medications for each situation and type of pain.

The use of drugs

The drug of first choice in mild-to-moderate pain without inflammation, such as In the case of teething, growing pains and migraines, it is acetaminophen administered orally, which pmay be administered from day one due to the excellent relationship in terms of effectiveness and safety. Paracetamol acts within 30 minutes or so, and its analgesic effect lingers for 4-6 hours. Il paracetamol can also be employed even on an empty stomach, to a dosage higher than that indicated for fever, as directed by the pediatrician, but always In relation to the child’s weight e without exceeding over the course of one day the threshold of 60 mg/Kg In children younger than 3 months of age e di 80 mg/Kg In larger ones. Rectal administration of the drug is to be left
always as an alternative, for example in case thechild is unable to take anything by mouth because of vomiting. For pain associated with inflammation after the third month of life and over 5.6 kg in weight, the ibuprofen, to be administered on a full stomach, based on weight and with an interval of at least 6-8 hours (as opposed to 4-6 hours for acetaminophen) and without exceeding the maximum dosage of 30 mg/Kg in a day.

In any case, it should be remembered that i treatment of pain, in order for it to be effective, must take place according to a fixed schedule and not on an as-needed basis

. Finally, if the pain is associated with local manifestations, such as discharge from the ear or redness or swelling after a fall, or if it should increase in intensity, it is always advisable to consult the pediatrician.

Among all disorders, pain is the one that most undermines the child’s physical and psychological integrity and in addition distresses and worries his or her family members, with a significant impact on quality of life and care. For this reason, it should not be underestimated, nor should it be trivialized: even in cases where there are reasons to suspect that a child may be feigning sickness, for example as an excuse for shirking a school commitment, it is always advisable to proceed with the appropriate checks rather than risk not caring or treating him or her roughly.

Mediterranean diet, Swedish children follow it more than Italian children

22 February 20246 January 2024 by Alessia Giannino

The Mediterranean diet is a nutritional model inspired by the dietary patterns prevalent in some Mediterranean countries.

In the 1950s, Ancel Keys, an American nutritionist, realized that populations in the Mediterranean basin were less susceptible to certain diseases than Americans. From this came the hypothesis of a diet that would increase longevity. The scholar, once back in America, continued his research until he wrote the book “Eat well and stay well, The Mediterranean way.”

Keys thought that the Mediterranean diet was ideal for reducing the incidence of “diseases of affluence,” in fact starting in the 1970s he tried to spread Mediterranean eating habits in his country as well.

The diet includes consumption of all products, favoring fruits, grains, vegetables, seeds and olive oil over the rarer use of red meat and animal fats. It does not exclude any food; in fact,fish, white meat, legumes, eggs, dairy products, sweets and red wine are also consumed. In addition, a food pyramid was created, showing the distribution and quantity of foods throughout the day. According to the pyramid, fruits can be taken 2-3 times a day, along with vegetables and greens, which are recommended in abundance. Milk and yogurt should also be consumed every day. In the middle of the pyramid, on the other hand, are the foods to be consumed several times a week, but not every day: fish, white meat, cheese. Then there are eggs and red meat, which is recommended to be consumed 1-2 times a week, and finally at the top of the pyramid are the foods to be consumed in moderation, namely sugars, sweets, sauces, butter and wine.

Italian children eat more “junk food”

In May 2018, at the European Obesity Society Congress, aWorld Health Organization study was presented showing that the Mediterranean diet is followed more in Sweden than in Italy. In fact, it seems that fish, vegetables and fruits are consumed less in Mediterranean countries than in other European countries. Specifically, the study showed that Swedish children eat more fish, olive oil and tomatoes than children in southern Europe, who often consume “junk food” such as snacks, sugary drinks and fatty foods. Obviously, the foods in the traditional Mediterranean diet are not products of the Nordic countries, but they have become part of their diet because of the important health benefits.

Data report that 42 percent of children in Italy are overweight. In northern nations, however, excess weight ranges from 5 percent to 9 percent. At the origin of these data is not only nutrition, but also the
physical activity, as in Italy and in all Mediterranean countries, higher physical inactivity was recorded than in northern countries.

These data seem to overturn what is actually thought, in fact living in a Mediterranean country does not mean having Mediterranean habits. Moreover, it is hard to imagine that there are fewer fast food restaurants in Sweden than in Italy. Another peculiarity is physical activity, which children in northern Europe, are more able to do despite bad weather and few hours of daylight. Life habits, therefore, can change in a healthier direction regardless of a country’s social and environmental contexts and traditions.

Meteorism: a disorder that affects young and old alike

25 February 20246 January 2024 by psalari

IMeteorism means distention of the abdominal wall due to gas accumulation in the intestines. It is a term widely used in adult and sometimes proposed not so much as a symptom, which in fact it is, but almost as a disease. It can actually occur in children as well, in whom it takes on a different meaning depending on the age group and the consequences it can have on both digestion and general well-being.

The causes

In other words, it is a phenomenon, or, if you prefer, disorder, which can be entirely nonspecific or become a valuable clue pointing toward a precise diagnosis. In the infant, for example, the most common cause is aerophagia, which is the ingestion of air, most often promoted by suboptimal breast anchorage or, in the case of formula feeding, a hole in the teat that is too small. Also in the first weeks of life, another determining factor is the feeding of the baby not at the first signs of hunger (waking from sleep, eye movement, tongue snapping and lip movements) but after the “explosion” of crying, which causes the baby to swallow air. Colic is then another physiological phenomenon that results in tension of the abdominal wall and, according to some, is an expression of a maturing process of the digestive tract.

The role of milk

Meteorism, however, can also be due to gastroenteritis, digestive difficulties, and food allergies: in the infant in first place we find cow’s milk protein allergy, while from weaning the most likely events are lactose and gluten intolerance. Lactose, in particular, in order to be absorbed, requires the intervention of lactase, which breaks it down into its two constituent units, glucose and galactose. The reduction of this enzyme, which occurs in some individuals, results in the retention of this sugar and its fermentation by the intestinal bacterial flora: hence the two unmistakable signs, meteorism and diarrhea, that occur after the intake of milk, dairy products and other foods containing Lactose. The suspicion initially arises on the basis of this direct association, but it can be easily and definitively confirmed by performing a simple test suggested by the pediatrician.Once the diagnosis is made, however, for the child it does not mean having to give up such an important food as milk and all foods that are sources of lactose: thanks to research, in fact, a preparation has been prepared that allows it to be degraded, thus obviating the lactase deficiency.

If a child, therefore, has not previously suffered from meteorism, it is always good to first observe the progress of this disorder and particularly whether it is affected by diet. In the case of its persistence or accentuation, it is always a good idea to consult your pediatrician in order to make a careful assessment, which will allow the appropriate investigations and necessary steps to be taken to limit or possibly avoid discomfort to the child, whether small or large.

The first task in resuming school: following proper nutrition

25 February 20246 January 2024 by psalari

Experts from the Grana Padano Nutrition Observatory (Ogp) to coincide with the resumption of school studies have investigated the eating habits of 500 school-age females and males, estimating the number of daily meals and total intake of daily macronutrients (protein, carbohydrates, and lipids) to make dietary suggestions that can improve the state nutrition of children. The study shows that as age increases, the number of meals decreases, and in particular the number of meals goes from the 5% Of children who do not eat breakfast in the under-6 age group at the 20% of 14- to 17-year-olds, despite the fact that the first meal of the day is crucial for them to cope with the morning’s study hours. The decrease in the number of daily meals increases with increasing age, ranging from 4.2% of children under 6 years old having only 3 daily meals to 22.1% over 14 years old. As people get older, they tend to lose the snack eo habit, which is 100% present in younger children.

Expert advice

To improve the nutrition of toddlers, experts from the Observatory have compiled 5 tips that should be strictly followed to feed children in the right way. Here they are:

Breakfast: is an important meal and should never be skipped, we recommend a carbohydrate portion (complex sugars needed by the brain) such as bread or rusk or cereal, preferably whole grain, with milk or yogurt. A small amount of jam or honey can also be used for spreading or to sweeten drinks.
Snacks/meal: prefer fresh seasonal fruit, or a low-fat yogurt including fruit, in some cases salty snacks, bread and cheese can also be recommended, especially if the kid has to sustain physical activity.
Fruits and vegetables: consume 3 servings of fruits and 2 servings of vegetables daily to ensure vitamins, minerals and the right amount of fiber.
Sweets: in moderation, ice cream or pastries once a week, limit added sugar and sugary drinks, prefer smoot hies or juices, drink only water at the table.
Fish: at least two to three times a week, ideally cooked simply, steamed or baked.
Nuts: walnuts, almonds hazelnuts, contain Omega 3 fats, 10-20 grams daily as a snack.

Gastroenteritis and food poisoning: a pitfall not only in summer

25 February 20246 January 2024 by psalari

For children, too, summer means sunny days, to be spent-sun and mugginess permitting-outdoors, simple nutrition rich in fresh foods, such as fruit, milk, ice cream-in short, freedom. Be careful, though. Some pitfalls are constantly lurking, and among them are no shortage of bacteria and viruses that prefer the
digestive system
. In short gastroenteritis and food poisoning are always around the corner, not only in the summer time but can be a danger all year round: the former are due to the entry of a germ, while the others are caused by the production by some particular bacterial species (salmonellae, clostridia, staphylococci, escherichia, to name a few), of toxins, that is, substances that can trigger fever, abdominal pain, vomiting and diarrhea within a few hours. Instead, toxins are said to occur when a food is a vehicle for both germs and related toxins.

Eye on food hygiene and beyond

Transmission of these forms is as simple as it is rapid: use of toilets not followed by proper handwashing, expired or inadequately handled, prepared, cooked or stored food, contaminated water, inadequately sanitized environments (especially kitchen and refrigerator) and dishes, and so on. Creams and egg products, for example, or vegetables that have not been well rinsed, artisanal cheeses of uncertain origin are all potential vehicles for microorganisms and toxins.

Children are even more vulnerable than adults, posing two problems: first, the massive loss of water and minerals, leading to the risk of dehydration (an emergency that, especially in the early years of life, may necessitate hospitalization). Second, subsequent inappetence and possible maldigestion, particularly of lactose. Often, in fact, with enteritis the absorptive cells of the intestine are damaged and thus lactase, the enzyme that breaks down lactose into its two constituent units, is reduced.

Symptoms

Thus, additional discomfort factors may be added to the initial manifestations, responsible for general malaise, decreased liveliness, and poor appetite. For this reason, after an episode of vomiting and/or diarrhea, it is prudent to limit the amount o fmilk and dairy products, reintroducing them gradually if possible. If, on the other hand, once the gastroenteritis has passed, lactose-containing foods become associated with abdominal bloating, meteorism, or other digestive disturbances, it is advisable to consult the pediatrician. The key word, in any case, always remains prevention: by adhering to simple hygienic rules and tricks, including paying attention to the origin of raw materials and checking the potability of water, many unpleasant mishaps can be avoided. Not only to the little ones but also to all their family members.

How important is sports for children

25 February 20246 January 2024 by clemente.ferrara

The vacations are almost over, September is approaching, and all the children are about to return to their school desks. Homework returns, friends are reunited, and the usual daily routne begins again. In addition to school, however, it would be highly recommended to engage the little ones in an extracurricular activity that is perhaps even more fun and dynamic for them: sports.

Why should children play a sport ?

Sports activity has always been recommended from an early age. This is for several reasons, first of all it is the most effective and efficient way to toughen children’s physiques as they grow. Muscles and bone structure are strengthened, and many diseases resulting from a sedentary and monotonous life (made even more so by children’s increasingly intensive use of technological devices such as smartphones, tablets, PCs, and game consoles), especially those related to nutrition and weight, are also prevented. The latter condition unfortunately affects a large number of boys and girls too often “parked” in front of TV screens.

Sports are also an excellent response to stress, feelings of loneliness, and help combat anxiety and depression. For these reasons, very often children who start a sports activity early on also perform better in school and develop their learning skills more. In addition, sports allow the child to store up a wealth of motor experience that will be invaluable throughout his or her life and will give him or her an advantage, especially in comparison with those who, on the contrary, have never participated in a sporting activity.

Sports and socialization

Another reason why sports are very useful for a child’s growth is related to the aspects of sociality and relationships with others. In fact, practicing a physical activity, especially group and team activities, helps children from an early age to relate to their peers, to play, to have fun together and to team up to achieve their team’s goals. In doing so, children gain a greater sense of responsibility that will motivate them to work harder and harder to help their teammates and lead them to victory. The important thing, however, is that there is always healthy competition and that it is very clear to everyone that the main purpose of a sporting activity, especially at that age, is primarily to have fun beyond the result.

In order to fulfill this important rule, the constant presence of parents is essential, and they should take a constant interest in their little one’s activities, accompanying and supervising him or her throughout the sports journey. Another key figure is also that of the instructor, who is a real reference point for the child. This is a figure who must go beyond mere technical teaching of the discipline but, on the contrary, must have excellent skills empathic, must be able to relate to children, listen to them, understand them, and instill in them a healthy love of sports through motivation and support during training.

The 7 main benefits

We have already seen how sports activity for young children is of paramount importance. In fact, there are numerous benefits of physical activity at the youngest age. Of all the 7 most important are:

Develops social skills: through sports, especially team sports, children are able to overcome their shyness and relate to others more easily and naturally. This interaction is driven by feelings common to all group members, such as team spirit, camaraderie, mutual loyalty, and above all, a desire to have fun.
Desire to improve oneself: through physical activity, a strong desire develops in the child to improve his or her skills, becoming better and better at the sport he or she plays, either for personal satisfaction or for competitive purposes.
Rules: with sports, children perceive more the importance of rules, which are the same for all team members and must be followed in order not to be excluded from the group.
Hygiene: it sounds strange but sports activity also improves children’s sense of hygiene. Indeed, they learn that after a physical activity it is important to take care of their own hygiene, out of respect for themselves but especially for others.
Obesity prevention: through a more dynamic and active lifestyle
Promotes sleep: after an intense training session, there is nothing better than a good, rejuvenating nap
Improves muscle elasticity, strength and posture

Infant and toddler (digestive) comfort: a new concept

25 February 20246 January 2024 by psalari

Comfort is synonymous with well-being. But what exactly does it mean? As is implicit in the manifesto of the Italian Society of Pediatrics published 3 years ago, well-being can be equated with the right of every child to have “a healthy life,” guaranteed by the “early acquisition of lifestyle healthy“, access to specialized care, prevention, and appropriate protection against of environmental risks and uncomfortable situations. In practice, however, well-being finds its own declination from time to time that suggests how much a disorder or even a seemingly physiological condition can take a physical and behavioral toll on the child and consequently on his or her family.

Digestive comfort

Thus, the concept of digestive “comfort” has been introduced in recent years, applied especially to the infant, who is notoriously prone to annoying gas colic. But what do parents need to know (and know how to observe)? The most common concern, but also the least alarming in the eyes of the pediatrician, is constipation, which, however, most of the time, is easily corrected by simple dietary measures (e.g., increasing water and fiber intake). Instead, it would be more important to pay attention to the child’s digestive behavior ( crying, for example, is a clue to suspicion), the ease, rather than the frequency, with which he or she evacuates, and the appearance of manifestations such as liquid discharges, copious gas emission, and discomfort.

All of these should be reported to the pediatrician on a timely basis, along with information about the child’s diet: this is because, especially in the first year of life, an allergy may manifest itself in an atypical manner, for example, with repeated episodes of acid reflux or marked abdominal bloating.

The risk of intolerance

Among the possible factors that can undermine digestive comfort from generally the age of one year and up is lactose intolerance: this is not an allergy but the inability to break down this sugar, which, accumulating in the intestine due to lack of absorption, ferments. In any case, digestive comfort is something that should always be assessed in the context of each child’s daily life, as it is closely integrated with his or her overall state of well-being. Parental attention is an invaluable support for the pediatrician in tracing the possible cause of the manifestations and identifying the most appropriate subsequent strategy.

Good night and its rituals

26 February 20246 January 2024 by marisadarrigo

It is known that children do not like to go to sleep. They are capable of suddenly collapsing half-heartedly, but if they are told it is time for bed they either tergiversate, make a thousand excuses, or, when they are particularly tired, seem to engage in a real battle against sleep (and also account for us!), with all deliveries on the tantrums, of whining, etc. But why all this? Is it just a matter of irritability, of bad manners, or does this difficulty have a deeper meaning that education should take into account?

Why don’t babies want to sleep?

Children live in the immediate, the younger they are the more the future ( and by future we also mean the morning after or the after afternoon nap) for them is something extremely vague and nebulous. Falling asleep is like leaving, like dying: losing everything, leaving objects and landmarks behind and sinking into a kind of “black hole” of unawareness. It is precisely this kind of perception that leads them to struggle against sleep experienced almost as a danger and not as a restorative embrace. The goal is not only that the child falls asleep but also that from this fundamental function that is repeated and will be repeated every day and several times a day the child can derive , alongside the good habit, a security of self, based on trust and constancy (of objects, affections, circumstances).

How to promote sleep

For as long as the world has been alive, specific ways have been developed to help children fall asleep: just think of lullabies, the act of rocking, the cradles named after that movement, the habit of telling or reading a story, to the favorite puppet (or blankie or rag), etc. Since time immemorial, to go to sleep, lights are dimmed, noises are dampened, that is, we try to create a situation as of “decompression” in which “exciting” sensory stimuli become more and more distant to make way for a reassuring, repetitive and fading rhythmicity.

All of these behaviors serve the function of promoting relaxation, containing the child, and accompanying the child on a potentially anxiety-inducing path of “abandonment.” It is important that this delicate moment, which among other things marks that essential rhythm of life given by the alternation of wakefulness and sleep, be “ritualized“, that is, have its own canvas (for each child and for each stage of growth, his own) that enshrines the meaning of the moment, its preparation, its unfolding; that contains and reassures the child, never making him feel at the mercy of unknown events; that provides him with awareness of what is happening to him and allows him, precisely by virtue of the space and time dedicated, to connect today’s “bedtime” with yesterday’s and with tomorrow’s awakening.

Endless can be the rituals of the Good Night, rituals made of play, of creativity, of rules, but all of them, like any self-respecting ritual, must be solemnized (that is, they must have their own consistency and constancy), shared among several people (the child and those accompanying him, even if simply reminding him that it is time to sleep), have meaning and purpose.

Avoid sleep caused only by exhaustion

Otherwise, when children are only able to fall asleep if they are “exhausted,” watching television on the sofa, in their parents’ bed or alone in their bedroom, they lose the ability to gain awareness of this function, that is, to enter the world of sleep confidently and voluntarily. Instead, they “fall” into it as if into a net without any preparation and basically without any accompaniment. Parents, who are supposed to provide the time, place and mode, instead seem in many cases to passively and laboriously point to their children’s “battery exhaustion,” becoming victims themselves of this confusing mechanism. The principle of all full all empty is substituted for the ability to regulate and pace energy.

So many sleep disorders in children and, especially, adolescents stem from precisely this initial failure to gain awareness, autonomy, and pleasure in regulating rhythms and needs.

Are there supplements that improve memory and school performance in the child?

25 February 20246 January 2024 by psalari

An interesting study recently published in the prestigious journal Nature points out how, to “build and maintain a complex brain,” our ancestors used nutrients found primarily in meat: iron, zinc, vitamin B12 and fatty acids. This is at the expense of plant-based foods that, while containing them, are still less rich in them. A diet low in meat, therefore, would expose one to risks of deficiencies in nutrients that are essential for the proper functioning of the central nervous system; on the other hand, it is now known that an excess of animal products has negative aspects, as it can promote serious chronic-degenerative diseases, such as cancer or cardiovascular disease, for example. Therefore, there must be a delicate balance in nutrition as well, and this is especially true in the very early stages of life, especially in the period between conception and the age of 2 years.

The most important nutrients

Two nutrients deserve special attention, precisely because they are strongly involved in brain development and, therefore, indirectly in memory as well: long-chain polyunsaturated fatty acids (LC-PUFAs) and iron.
LC-PUFAs regulate the fluidity and enzymatic activities of cell membranes. Among them, the effect of DHA is especially noticeable during the delicate period when the nervous system of the fetus and infant/infant is formed: it preferentially accumulates in the frontal cortex and retina, thus assuming a key role in the structural development of the brain. It has been reported that infants fed formula containing DHA have better eye and motor coordination, greater concentration and higher scores on intellectual tests, and better logic skills. DHA and in general and LC-PUFAs are therefore considered essential nutrients for the development and maintenance of memory during all stages of life.

Iron is the second essential micronutrient: in addition to being critical for oxygen transport to peripheral tissues, it is involved in the production of myelin (the sheath that surrounds nerve fibers) and the neurotransmitters dopamine and serotonin. Several studies report that its deficiency has negative effects on memory, learning, and social interactions. The periods most at risk are those of intense growth of the body, thus pregnancy and fetal development, childhood and adolescence. The effects are reduced spatial memory in adolescence, reduced attention, and worse cognitive performance, manifested by lower school performance, poor test performance, and increased irritability and restlessness.

Between the digestive system and the immune system: the gut in the early ages of life

25 February 20246 January 2024 by psalari

The bowel, anyone would say, is the body in charge of the digestion and assimilation: its conformation to tube and its motility, in fact, enable it, thanks to enzymes, to break down ingested foods into their individual components (so-called nutrients), absorb them into the circulatory stream, and finally “push” unusable food residues so that they are eliminated in the form of feces.

The gut as an immune organ

Nothing to object to except for the fact that in this cursory overview another function no less important than those described has been omitted: the gut, in fact, is also an immune organ whose task is crucial in the early ages of life. Let us reflect for a moment: the absorbent mucosa, which in the adult individual has an area of as much as 400 square meters, can be considered on a par with the skin. Similarly to it, in fact, although it constitutes the inner lining of the intestine, it is constantly in contact with what comes from outside and thus plays a role as both a sentinel and a barrier.

The wall of the intestine, on the other hand, is rich not only in blood vessels, which receive nutrients and distribute them to all tissues of the body, but also in lymph vessels, where lymphocytes circulate. In fact, these particular highly specialized white blood cells, after forming in the bone marrow, need to be “trained” to perform their defensive task and find precisely in the digestive tract the optimal site for their break-in, also thanks to the presence of the bacterial flora.

A protection for the little ones

In the young child, then, let us not forget that the introduction of any new food is perceived as a potential aggression. In practice, the immune system cannot distinguish between a virus and a food protein, but thanks to special systems it develops what is known as tolerance: that is, it suppresses the mechanism by which contact with various foods would trigger the reaction underlying intolerance, namely the allergic response.

By 2022, obese children will outnumber underweight children

25 February 20246 January 2024 by clemente.ferrara

We all know how important it is for the well-being of the body to keep a proper diet. This is especially crucial when it comes to children. Eating problems are unfortunately widespread among younger people, although we are seeing a substantial shift from the past. Until now, in fact, the problem of malnutrition mainly affected children who are in the underweight condition, especially in the poorest parts of the planet. The numbers are changing, however, and a new scenario, in some ways opposite to the past, seems about to occur.

The study

According to research published in Lancet, the most important (in terms of numbers) on the study of obesity carried out in the past 40 years, five years from now the number of obese children will exceed the number of underweight children. Weight and height of about 129 million subjects in an age range of 5 to 19 years were analyzed. The first worrisome finding from this study is that over the past 40 years the number of overweight children has become 10 times larger, rising from 11 million in 1975 to 124 million in the past year (moreover, there were about 213 million children just below the obesity threshold in 2013).

Blame it on a lifestyle that is certainly more sedentary than in the past but not only that. One of the main causes, according to experts, would also be the increase in poverty. In fact, the economic crisis has taken away the opportunity for more and more people to buy healthy foods with high nutritional values, forcing them to fall back on junk food, most often cheaper than others.

Statistics

According to the survey by Imperial College London, the number of obese children has risen from 1 percent recorded in 1975 to 6 percent for girls and even 8 percent in boys in 2016. An entire generation, therefore, is growing up affected by malnutrition. This time, however, unlike in the past, the trend is reversing in favor of overweight children, who are in ever-increasing numbers.

Despite this, even on the side of underweight children, the situation does not seem to be improving at all. In fact, in 2016 the average or severely underweight individuals were about 75 million for girls, and well 117 million for boys, who are concentrated more in the world’s poorest areas (two-thirds of them live in the south of Asia where high population growth is failing to come to terms with policies put in place by the government against malnutrition).

Is there such a thing as intestinal flu in children?

25 February 20246 January 2024 by psalari

Sometimes the popular imagination creates expressions that, while making no claim to scientificity, render the concept or impact of a particular condition so well that they enter common usage and even medical jargon. One example is the so-called “intestinal flu“-a designation that is not among the official diseases and yet it always catches on, raising no objections, for at least two reasons. First of all, because the real flu, that is, the flu caused by influenza viruses, in addition to the respiratory tract, especially in children, can also lead to digestive disorders. Second, because the very term “influence” suggests the idea of alteration.

The danger of viruses

But beyond these linguistic disquisitions, let us see why and how really many viruses in children can affect the airway and intestines. There are basically two mechanisms: first, the most prevalent viruses have the ability to attack the mucous membranes, that is, the internal lining tissues. As much as some have a greater propensity for one district, they may in fact find different routes of access, taking advantage of some structural similarities between respiratory and intestinal mucosa. This justifies why in children even a trivial cold can be associated with digestive disorders (nausea, vomiting, diarrhea).

Second, we should not forget that the entry of a germ into the gut often disrupts its bacterial flora, thus changing that delicate balance that is fundamental to its very functioning. Here then is the onset, once again, of bothersome manifestations, ranging from inappetence (instinctively the child has little motivation to eat because he or she associates the introduction of food with an unpleasant sensation) to liquid discharges. It may also happen, then, that a virus, by its mere presence, although not devastating, promotes the establishment or proliferation of more aggressive bacteria, which can worsen the already existing clinical picture, leading to further momentary discomfort and difficulty in the absorption and digestion of some components, including the lactose (the possible use of a lactase preparation, if necessary, will allow continued intake).

In conclusion, when we hear about stomach flu, we must always try to understand how this wording is understood: is it, in short, an actual flu that has gone beyond the airways or a full-fledged gastroenteritis? In any case, the use of a probiotic will be useful and advisable, both to stimulate the immune system and to counteract the pathogen and promote its elimination.

Those strange recurring stomach aches

24 February 20246 January 2024 by psalari

If we think back to our childhood, among the many experiences we are able to recall, there is certainly no shortage of at least one stomach ache: associated with classic indigestion, gastroenteritis, the intake of an expired food rather than a trip. An episode, in short, that left a memorable mark. Usually, in fact, stomach ache is an acute and mostly occasional event.

In some children, especially around school age, however, it becomes recurrent: pain attacks, in practice, recur with a fairly regular, indeed cyclical, cadence, usually monthly. Initially, one would come to think of the classic subterfuge that children resort to in order to evade their commitments and responsibilities. But what is surprising sooner or later is that these “seizures” appear regardless of school or other factors: perhaps before an outing, a party, or another pleasant moment, which the child will be forced to give up. If we then investigate further we find that in most of these cases there is familiarity with migraine. And perhaps kinetosis, i.e., motion sickness, seasickness, or similar transportation-related disorder, also emerges. What does all this mean then?

These recurrent bellyaches, which almost never miss an appointment, delineate what is known as the periodic syndrome or abdominal migraine: a curious manifestation that can last up to 72 hours accompanied by cramping in the center of the abdomen, vomiting, poor appetite, and often pallor, ringing in the ears, and visual changes. The designation of “migraine” is not coincidental considering that the gut has been aptly dubbed the “second brain” and shares with the central nervous system numerous mediators including in particular the serotonin: Indeed, it plays a decisive role in the periodic syndrome, the dynamics of which, moreover, are not entirely clear. Treatment must necessarily be individualized and, above all, must take into account any related symptoms, starting with those that may lead back to an initial and still nuanced form of migraine.

Of course, it is crucial to differentiate recurrent stomach pain from other types, for example, from that due to lactose intolerance. In fact, the latter can often take on a rather insidious character, resulting in abdominal pain, diarrhea, and sometimes vomiting not immediately after ingestion of this sugar but upon exceeding a certain threshold.

How to help your child in the strenuous “recovery” of the intestines after the holidays

24 February 20246 January 2024 by psalari

A classic request that parents make to the pediatrician at this time is whether there is any provision for “Getting your child’s gut back on track” after the holidays. In fact, especially with regard to the Christmas season, it should be remembered that it is not only the dietary transgressions to cause disorders, but the many circulating viruses are also to blame, which can disrupt the Digestive system, sometimes in mutual concatenation

It may also be the case, for example, that classic indigestion, in addition to causing discomfort, alters the bacterial flora, making the gut more vulnerable to pathogens. Or a microorganism, which initially causes fever, cough, and other respiratory symptoms, may also promote nausea, vomiting, liquid discharges, and interfere with digestive processes.

What then are the best measures to help the child get better? First of all, let us remember that children, although they appear voracious and able to metabolize any mess, are no less delicate than adults: the difference lies in the fact that in the latter the symptoms are perhaps more pronounced but tend to resolve more quickly, whereas in children, if acute attacks of (liberating) vomiting or diarrhea are excluded, recovery times are slower, as well as longer vague abdominal pain, bloating or changes in fecal consistency and characteristics may persist, subtly.

To combat all these symptoms, it is first of all advisable to follow a simple diet: not necessarily “plain,” but characterized by lightly seasoned and elaborate dishes, such as spaghetti with tomato sauce, grilled steak or fish, pasta and beans, and minestrone. Also crucial is a proper balance between animal and vegetable foods: fruits and vegetables should never be missing from the table, and if they were really not liked by the child, we remember that, albeit with a loss of fiber, these sources of very important nutrients can be offered in the form of juices and centrifuges, prepared at home and consumed at the moment.

Pay attention, then, to the quantities of meals eaten throughout the day. If disturbances are present, it is better for them to be light and frequent rather than sparse and abundant. Fats deserve special mention; their intake should be moderated not only as a matter of calories but also because these substances slow down and weigh down digestion.

Finally, let’s not forget the importance of physical activity, which acts as a favorable stimulus on the motility of the digestive tract, and the intake of probiotic preparations, which are useful in restoring a balanced intestinal microflora arrangement.

Oral hygiene in children: instructions for use

24 February 20246 January 2024 by psalari

Children’s mouths are characterized by rapid growth and deserve special attention. Aesthetic appearance is important, but what really matters is that the teeth are healthy and that chewing function takes place properly, without, for example, areas of abnormal contact, overloading, or malocclusion. But how to address the issue of proper oral hygiene in children? How to brush teeth?

Oral hygiene in children

Children are easily infected by the enthusiasm of play and the driving force of the example of adults.

Ministry of Health’s suggestions.

The first good rule for parents is therefore to avoid making oral hygiene an imposition: every gesture and invitation should occur as naturally as possible, like any ritual associated with a particular time of day. After all, even we adults, if we get used to always having a clean mouth, do not mind brushing our teeth; on the contrary, it becomes an indispensable requirement. First oral hygiene should begin by passing gauze over the dental arches to remove milk clots. As the first teeth erupt, they recommend twice-daily brushing with a small soft-bristled toothbrush and parental supervision until the child becomes sufficiently familiar.

Also the guidelines point out that the use of an electric toothbrush with a rotary-oscillating motion further increases the effectiveness of manual brushing and is indicated to improve the performance of oral hygiene tasks and in children with poor manual dexterity. In addition, the pleasure of using such a device, designed specifically to strike the imagination, can also become an excuse that entices the child to pay attention to oral hygiene and, above all, to devote the right amount of time to it (an average of 30 seconds per hemiarch, 2 minutes in total). The availability of different heads and appliances in various cost ranges, among other things, allows each parent to choose the solution he or she feels is best, with the understanding that an electric toothbrush is a small investment that pays for itself in a short time in terms of convenience and effectiveness.

Toothpaste, mouthwash, and dental floss are essential garrisons to be introduced as the child learns to use them properly. Periodic visits to the dentist, beginning in preschool and repeated 1-2 times a year, are of course an indispensable adjunct, with the aim of tracking mouth development and dental health.

The brains of abandoned children

23 February 20246 January 2024 by Redazione My Special Doctor

Alterations in key nerve circuits, but with family foster care, recovery is possible

A research team from Harvard Medical School‘s Boston Children’s Hospital has documented, in JAMA Pediatrics, the alterations that occur in the brain circuits of children who lived in orphanages in Bucharest. The study, which began in 2001, is part of a project, called the Bucharest Early Intervention Project, involving the 6 orphanages in the Romanian capital, three U.S. Universities led by Harvard, three Foundations, led by the Mac Arthur Foundation of Chicago, whose goal is to examine the effects of childhood institutionalization on brain and behavioral development and, at the same time, to test whether family foster care has the ability to recover from brain damage.

The characteristics of the study are very unique. 136 children around two years of age, who had been in an orphanage since birth or at least for a few months after birth, were randomly divided (randomized) into two groups, one sent to foster care and the other who remained in the orphanage. A choice that instantly puzzles, but it should be known that, prior to this project, there was no adoption program in Bucharest, which therefore begins with the activity of the U.S. group, which covers the costs of fostering and the training of social workers who will be responsible for providing ongoing support to foster families. Finally, the study included a control group consisting of Bucharest children of the same age living with their families. All children were observed for about 8 years at regular intervals, monitoring their intellectual and behavioral development until then ages 9 to 11. Finally, a sample from each of the three groups was selected to be subjected to a meticulous and extensive brain investigation carried out using the Diffusion Tensor technique. This technique, abbreviated DTI (tensor diffusion imaging), allows visualization of the bundles of white matter fibers that connect brain areas to each other.

Children in orphanages showed alterations in white matter microstructure in a number of circuits and namely: the central part (so-called body) of the corpus callosum, cingulum, corona radiata, fornix, external capsule, retro-lenticular area of the internal capsule, and medial lemniscus. Brain images of all these brain circuits of institutionalized children, with the only exception of the retro-lenticular area of the internal capsule, show linkage deficits, which also explain the behavioral, cognitive and emotion management disorders that, with greater frequency, are present in these abandoned children. Intriguing is the exception of the retro-lenticular area of the inner capsule, which, instead of ‘weakening, is shown to be thickened and thus more functional. This area is part of the visual system and is the sensory area studied along with the medial lemniscus, which is a nerve pathway that transports sensation from the body to the brain, which, on the other hand, is deficient like all other circuits. One would think that in institutionalized orphans there would be greater visual acuity, as a need to be alert at all times, and poor tactile sensitivity, a dulling of the senses from lack of caresses and more generally from poor human contact .

Children in foster care, on the other hand, show brain images quite similar to children living with families, although some alterations in the white matter are still visible in the corpus callosum and corona radiata. This study is of great importance not because it is the first. Most recently, work by RJ Davidson’s group at the University of Wisconsin-Madison, in Biological Psychiatry on Feb. 15, documents, in children who have been abandoned or subjected to physical abuse or economic misery, structural alterations on key gray matter areas such as the amygdala and hippocampus. The importance of the Harvard study lies in the fact that it is a randomized controlled, prospective design with within it the demonstration that family foster care is not only an ethical obligation to these “innocents” (after whom the famous orphanage in Florence was named), but it is also an effective health intervention, which even in our country, which has abolished orphanages since 2006, it would be appropriate to extend without delay. There are about 15,000 minors in foster homes, which are certainly not orphanages but are obviously not families either, with an estimated economic cost of more than 40,000 euros per year per child. This money could be better spent.

by Francesco Bottaccioli

Counteracting the development of myopia in children with light

22 February 20246 January 2024 by rosanna.feroldi

To reduce the risk of developing myopia, children’s eyes should be exposed to both the bright bright light typical of a sunny day and the dim light found in dimly lit rooms: only in this way can the different types of photoreceptors be properly stimulated.

Myopia is an extremely common vision defect in people of all ages, typically arising in childhood/adolescence and then worsening in adulthood, sometimes complicating during aging with additional issues such as glaucoma, retinal detachment, or cataracts.

According to estimates, by 2050, about half of the world’s population will be affected by myopia and at increased risk of visual impairment. And, perhaps, this is a benevolent estimate, when one considers the negative impact that protracted exposure to screens of smartphones, computers, tablets, etc. and often inadequate lighting conditions is already having both in the home and in the workplace.

Given that, once established, myopia is difficult to recover from, in order to contain the size of what can be considered a true epidemic and protect the eyesight of millions of people, it is necessary to foster efficient eye development and prevent the onset of the visual defect from an early age.

According to studies conducted so far, it may not require drugs or other specific interventions to do so: it would be enough to regularly expose children ‘s eyes to the right light, that is, light that can properly stimulate the photoreceptors in the retina (cones and rods).

In this regard, data obtained, first in animal models and then in humans, indicated that exposure to bright bright light, typical of sunny days, has a preventive action against myopia. Specifically, one study reported that children exposed to bright ambient light for longer periods of time during play or outdoor physical activity were less likely to develop myopia. While another investigation found that myopic children tend to stay indoors more often and, therefore, benefit less from the positive stimulus of bright light.

On the other hand, a recent study conducted at the Georgia Institute of Technology in Atlanta, U.S., warns that it is not only the bright light of the outdoor environment that has a protective effect against myopia, but also the soft light typical of evenings or dimly lit rooms. The finding, only seemingly in antithesis with the previous one, is justified by the fact that the eye is a very complex organ, comprising photoreceptors of different types, naturally stressed by light radiation of different wavelengths.

Bright light better stimulates the cones, which are responsible for color vision, while dim light better stimulates the rods, which are the photoreceptors responsible for picking up less intense radiation and responsible for black-and-white vision, which is typical in situations where lighting is poor. To effectively prevent pediatric myopia, balanced exposure to both bright and soft light appears to be necessary to allow all components of the eye to develop to their fullest and most harmonious potential.

Source

Landis EG et al. Dim Light Exposure and Myopia in Children. Invest Ophthalmol Vis Sci. 2018;59(12):4804-4811. doi:10.1167/iovs.18-24415

How to treat encephalitis

15 February 20246 January 2024 by Redazione My Special Doctor

Encephalitis is an inflammatory process of the central nervous system in which the major area is the brain parenchyma. If spinal, sensory, and motor roots are also involved, the term radiculitis is used. They are in 25% of cases a precise etiology can be identified. Most cases, in fact, are viral in origin. Other causes may be allergies or absorption of toxic substances.

Some children may seem only modestly affected at first, but then it rapidly evolves to a comatose state until death. In the event that herpetic encephalitis is diagnosed, treatment is nonspecific and empirical and should be directed toward maintaining vital and supportive functions. As long as a bacterial cause or brain abscess has not been ruled out, antimicrobial therapy can be started.

All patients with severe symptoms should be monitored in an Intensive Care Unit. It is necessary to perform the same laboratory tests implemented for meningitis, including lumbar puncture.

Too much gluten in young children could increase risk of celiac disease

15 February 20246 January 2024 by Renato Torlaschi

High gluten intake early in life was associated with an increased risk of celiac disease in a new study by a team of researchers in northern Europe.

“We found that a one-year-old child in the highest range of gluten intake has twice the risk of developing autoimmunity of celiac disease, a stage that often preludes to full-blown celiac disease; â€ research coordinator Karl Marild of theNorwegian Institute of Public Health and Queen Silvia Children’s Hospital in Gothenburg, Sweden-. It was surprising to me to find such a strong association, given the ubiquitous nature of gluten in our diet.”

Marild and colleagues used data on 1,875 children provided by another study (Daisy – Diabetes AutoImmunity Study in the Young) that aimed instead to investigate susceptibility to type 1 diabetes mellitus. Among the plus points was the very long follow-up: participants were followed from 1993 until January 2017. The children were divided into three groups according to their dietary gluten intake during the period when they were one year to two years old. The researchers then compared the data of the now-adult participants in the higher gluten intake bracket with those in the lower bracket, showing for the former a 96 percent higher risk of celiac disease and 117 percent higher risk of celiac disease autoimmunity: in other words, a doubling of risk. “If our results are confirmed ,” said Marild. may provide a somewhat better understanding of a significant aspect of the likely multifactorial etiology of this disease. Importantly, we do not recommend a change in pediatric feeding practices, because ours was an observational study and unable to show a cause-and-effect relationship.” It is also necessary to specify that the consumption of gluten-rich foods in non-celiac adults has never been associated with any adverse effects. Gluten-free diets, much in vogue in the United States, challenging, unnecessary and expensive, may carry risks, and their health effect is among the many unproven but widespread “hoaxes” in nutrition.

Mårild K, Dong F et al. Gluten Intake and Risk of Celiac Disease: Long-Term Follow-up of an At-Risk Birth Cohort. Am J Gastroenterol. 2019 May 9.

Urgent endoscopy in pediatrics

16 February 20246 January 2024 by Redazione My Special Doctor

Digestive endoscopy with fiberoptic instruments is also considered a routine technique in the pediatric age group. The examination often needs to be performed urgently, within 24 to 48 hours of the onset of the event that required its performance. High endoscopy is performed when faced with upper gastrointestinal tract bleeding, suspected caustic ingestions, foreign body ingestions, melena, and esophageal varices.

Procedures for endoscopic examination are: taking Diazepam, general anesthesia, transfusion therapy in case of acute anemia, endogastric lavage in case of bleeding, and intestinal cleansing with saline rectoclysis.

In all cases it is essential to perform: blood count, PLT, blood group, blood glucose, azotemia, electrolytes, p-cholinesterase, PTT, CPH, ECG.

Source: Medical Emergencies in Pediatrics by Mediserve edited by Maurizio Vanelli

What to do in case of endocranial hypertension?

15 February 20246 January 2024 by Redazione My Special Doctor

Symptoms of endocranial hypertension in infants are: increased head circumference, tense and pulsating anterior fontanel, waning sun sign, vomiting, lethargy, papilledema. In children, on the other hand, headache, vomiting, altered consciousness and papilledema occur.

Laboratory tests to be performed are brain or echocerebral CT scan and EEG. Treatment with head elevation, hyperventilation, diuretics or osmotics, short costeroids, hypothermia and barbiturate coma is required.

Source: Mediserve‘s Medical Emergencies in Pediatrics.

Laryngitis-tracheo-bacterial bronchitis: what to do?

15 February 20246 January 2024 by Redazione My Special Doctor

This is an infection of the subglottic tissue characterized by the presence of purulent discharge. The most frequent pathogen is staphylococcus, followed by streptococcus and pneumococcus. It is a rare disease that occurs in children under the age of six. The presenting symptoms are: septic status, fever, stridor and cough, rapidly worsening dyspnea.

It is very important to tranquilize the child right away and undergo chest Rx and/or lateral neck Rx, fiberoptic nasopharyngoscopy. Usually intravenous antibiotic therapy with Teicoplanin 10 mg/kg, Ceftriaxone 50 mg/Kg/day and Chloramphenicol 100 mg/kg/day is recommended.

Source: Mediserve‘s Medical Emergencies in Pediatrics.

Essential hypoglycemia in children

15 February 20246 January 2024 by Redazione My Special Doctor

Hypoglycemia is the most common acute complication associated with diabetes. In children, symptoms may include irritability, asthenia, anxiety, hunger, headache, sweating, pallor, tachycardia, ataxia, and coma. It is necessary to maintain respiration and perform some laboratory tests, such as blood glucose, azotemia, electrolytes, creatininemia, transaminases, arterial pH, insulinemia, ketonemia, lactacidemia, ECG, phosphatemia, and urinary glucose.

As for treatment, glucose is usually administered. As an alternative to this, glucagon or diazoside can be administered in cases of severe hyperinsulinemia.

Source: Mediserve‘s Medical Emergencies in Pediatrics.