From PEDIATRICS Vol. 121 No. 5 May 2008, pp. 1062-1068 doi:10.1542/peds.2008-0564
The AAP Committee on Nutrition has updated its 1998 statement on the use of soy protein–based formulas in infant feeding.
In term infants, the few indications for use of soy formula in place of cow milk-based formula are: (a) for infants with galactosemia and hereditary lactase deficiency (rare) and (b) in situations in which a vegetarian diet is preferred.
Note:
1) For infants with documented cow milk protein allergy, extensively hydrolyzed protein formula should be considered, because 10% to 14% of these infants will also have a soy protein allergy.
2) Most previously well infants with acute gastroenteritis can be managed after rehydration with continued use of human milk or standard dilutions of cow milk-based formulas. Isolated soy protein-based formulas may be indicated when secondary lactose intolerance occurs.
3)Isolated soy protein-based formula has no advantage over cow milk protein-based formula as a supplement for the breastfed infant, unless the infant has one of the indications noted previously.
4)Soy protein-based formulas are not designed for or recommended for preterm infants.
5)The routine use of isolated soy protein-based formula has no proven value in the prevention or management of infantile colic or fussiness.
6)Infants with documented cow milk protein-induced enteropathy or enterocolitis frequently are as sensitive to soy protein and should not be given isolated soy protein-based formula. They should be provided formula derived from hydrolyzed protein or synthetic amino acids.
7)The routine use of isolated soy protein-based formula has no proven value in the prevention of atopic disease in healthy or high-risk infants.
Community North hospital will be providing monthly Grand Rounds with CME on pediatric topics effective October 1,2008. We will provide these offerings on the 1st Wednesday of each month at 7:30 am, in the multi-service conference rooms on the 3rd floor of the professional building. Breakfast refreshments will be served.
Our first speaker will be Community’s new pediatric neurologist, Dr Deb O’Donnell, who will be speaking on the Epidemiology of Seizures. This will be a great opportunity to meet Dr O’Donnell and learn more about pediatric seizures. If you have any questions about this, you can contact Dr Robert Lindeman at Community North’s pediatric unit 317-621-5474.
Vitamin D Deficiency in Young Children
Suboptimal vitamin D levels are common in healthy infants and toddlers.
From: Arch Pediatr Adolesc Med. 2008;162(6):505-512.
Recent research suggests that vitamin D deficiency is more common than we once thought. To examine vitamin D status in young children, Boston investigators determined vitamin D levels (25-hydroxyvitamin D) in 247 infants (age, birth to 1 year) and 133 toddlers (age, 1–2 years) during routine visits at an urban primary care clinic.
The prevalence of vitamin D deficiency (<20 ng/mL) was 12%, and 40% of children had suboptimal vitamin D levels (<30 ng/mL). Prevalences were similar in infants and toddlers. Among children with vitamin D deficiency, wrist and knee radiography revealed that 8% had rachitic changes, and 33% had evidence of demineralization. The only factors independently associated with vitamin D deficiency were breast-feeding without supplementation in infants and low milk intake in toddlers.
Comment: As noted by an editorialist, the level of vitamin D that truly represents deficiency in asymptomatic children is uncertain. However, because demineralization of bone during childhood can have lifelong consequences, ensuring adequate intake of vitamin D is important. The American Academy of Pediatrics recommends 200 IU of supplemental vitamin D for all breast-fed infants, unless they are receiving 500 mL daily of vitamin D–fortified formula or milk. They also recommend that toddlers consume 500 mg of calcium in their diet daily to assure adequate stores.
AAP Issues New Guidelines on Cholesterol Screening (Significant Revision)
Below is a policy on a clinical report appearing in the July issue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of Pediatrics (AAP).
The American Academy of Pediatrics has issued new cholesterol screening and treatment recommendations for children. The policy statement, "Lipid Screening and Cardiovascular Health in Childhood," recommends cholesterol screening of children and adolescents with a family history of high cholesterol or heart disease. It also recommends screening patients whose family history is unknown or those who have other factors for heart disease including obesity, high blood pressure or diabetes. Screening should take place after age two, but no later than age 10. The best method for testing is a fasting lipid profile. If a child has values within the normal range, testing should be repeated in three to five years. For children who are more than eight years old and who have high LDL concentrations, cholesterol-reducing medications should be considered. Younger patients with elevated cholesterol readings should focus on weight reduction and increased activity while receiving nutritional counseling. The statement also recommends the use of reduced-fat dairy products, such as two percent milk, for children as young as one year of age for whom overweight or obesity is a concern.
PEDIATRICS Vol. 121 No. 6 June 2008, pp. 1281-1286 (doi:10.1542/peds.2008-0939)
Simple febrile seizure is a benign and common event in children between the ages of 6 and 60 months. Nearly all children have an excellent prognosis. Although there is evidence that both continuous antiepileptic therapy with phenobarbital, primidone, or valproic acid and intermittent therapy with oral diazepam are effective in reducing the risk of recurrence, the potential toxicities associated with antiepileptic drugs outweigh the relatively minor risks associated with simple febrile seizures. As such, long-term therapy is not recommended. In situations in which parental anxiety associated with febrile seizures is severe, intermittent oral diazepam at the onset of febrile illness may be effective in preventing recurrence. Although antipyretics may improve the comfort of the child, they will not prevent febrile seizures.
Read the full guideline on the AAP web site below.
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;121/6/1281
The
Read the full statement on the AAP web site below along with background material.
From PEDIATRICS Vol. 119 No. 1 January 2007, pp. e124-e130 doi:10.1542/peds.2006-1222)
This study looked at the effectiveness of Lactobacillus Reuteri in the treatment of Infant Colic (108 live bacteria per day). Infants receiving L reuteri showed a significant reduction in daily crying time by day 7, compared with infants treated with simethicone. On days 14, 21, and 28, crying times were significantly different between the 2 treatment groups. At the end of the study (day 28), the median crying time in the probiotic group was 51 minutes/day (range: 26–105 minutes/day), compared with 145 minutes/day (range: 70–191 minutes/day) in the simethicone group, with a difference of 94 minutes/day. On day 28, 95% were responders in the probiotic group and 7% were responders in the simethicone group.
Are you using probiotics in infant colic? Please relate your experience in the comments below.
The American Academy of Pediatrics endorsed the publication: Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis. Guidelines from the American Heart Association. A guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007;
Infective endocarditis prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis. Those are prosthetic cardiac valve, previous IE, unrepaired cyanotic congenital heart disease (CHD) including palliative shunts and conduits, completely repaired congenital heart defect with prosthetic material or device during the first 6 months after the procedure, repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device which inhibit endothelialization, cardiac transplantation recipients who develop cardiac valvulopathy. For patients with these underlying cardiac conditions, prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure.
Refer to the publication below for more background and details:
http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.106.183095v1.pdf
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